Provider Demographics
NPI:1972871044
Name:BEAUCHAMP, JANMARY (PA)
Entity Type:Individual
Prefix:
First Name:JANMARY
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2600 LAKE LUCIEN DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7233
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-875-0518
Practice Address - Street 1:2893 ENTERPRISE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2784
Practice Address - Country:US
Practice Address - Phone:386-789-8600
Practice Address - Fax:386-789-0219
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant