Provider Demographics
NPI:1891722872
Name:PERRY, BETH ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:PERRY
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:6559 N WICKHAM RD STE C-105
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2039
Practice Address - Country:US
Practice Address - Phone:321-395-3298
Practice Address - Fax:321-241-1161
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02723363AM0700X
FLPA9109586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02723OtherTSBPAE
FLPA9109586OtherFLORIDA BOARD OF MEDICINE
1046057OtherNCCPA
TXPA02723OtherTSBPAE