Provider Demographics
NPI:1255760674
Name:UMANSKY, BETH (PA-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:UMANSKY
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 1:1330 SE 4TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1958
Mailing Address - Country:US
Mailing Address - Phone:954-463-3804
Mailing Address - Fax:954-463-3805
Practice Address - Street 1:1330 SE 4TH AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1958
Practice Address - Country:US
Practice Address - Phone:954-463-3804
Practice Address - Fax:954-463-3805
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107407363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical