Provider Demographics
NPI:1003068214
Name:BEAMS, LEANDER JOSTIN SR
Entity type:Individual
Prefix:MR
First Name:LEANDER
Middle Name:JOSTIN
Last Name:BEAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LEANDER
Other - Middle Name:JOSTIN
Other - Last Name:BEAMS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3100 LANDINGS CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-0018
Mailing Address - Country:US
Mailing Address - Phone:619-251-7696
Mailing Address - Fax:
Practice Address - Street 1:45 MCLEOD ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3523
Practice Address - Country:US
Practice Address - Phone:321-452-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily