Provider Demographics
NPI:1891384269
Name:BEACH, ERIN NICOLE (DNP, CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:BEACH
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 COLINA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2617
Mailing Address - Country:US
Mailing Address - Phone:585-406-3112
Mailing Address - Fax:
Practice Address - Street 1:900 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3902
Practice Address - Country:US
Practice Address - Phone:817-877-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered