Provider Demographics
NPI:1710767272
Name:BEACH, HAILEY ADISON (PA-C)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ADISON
Last Name:BEACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 ANTICA ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-1500
Mailing Address - Country:US
Mailing Address - Phone:386-341-9246
Mailing Address - Fax:
Practice Address - Street 1:2411 W BELVEDERE AVE STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5217
Practice Address - Country:US
Practice Address - Phone:386-341-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant