Provider Demographics
NPI:1902182447
Name:HALL, BEATRICE E
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:E
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 SOUTEL DR.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-3738
Mailing Address - Country:US
Mailing Address - Phone:904-465-5471
Mailing Address - Fax:
Practice Address - Street 1:5838 SOUTEL DR.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219
Practice Address - Country:US
Practice Address - Phone:904-465-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 248500376K00000X
FL251S00000X
FLFB 9721679374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No376K00000XNursing Service Related ProvidersNurse's Aide
No374700000XNursing Service Related ProvidersTechnician