Provider Demographics
NPI:1679092738
Name:BEADLES, ELIZABETH MEI LAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MEI LAN
Last Name:BEADLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22025
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-2025
Mailing Address - Country:US
Mailing Address - Phone:941-477-4007
Mailing Address - Fax:877-239-7174
Practice Address - Street 1:315 NOKOMIS AVE S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2417
Practice Address - Country:US
Practice Address - Phone:941-477-4007
Practice Address - Fax:877-239-7174
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2023-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111244363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant