Provider Demographics
NPI:1811390164
Name:BEAUVIL, MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:BEAUVIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:BEAUVIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:707 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2937
Mailing Address - Country:US
Mailing Address - Phone:863-521-5436
Mailing Address - Fax:
Practice Address - Street 1:707 25TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2937
Practice Address - Country:US
Practice Address - Phone:863-521-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health