Provider Demographics
NPI:1063143493
Name:BEASCOECHEA, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BEASCOECHEA
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 1:422 MAJESTIC GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5733
Mailing Address - Country:US
Mailing Address - Phone:863-514-4984
Mailing Address - Fax:863-514-4984
Practice Address - Street 1:422 MAJESTIC GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-5733
Practice Address - Country:US
Practice Address - Phone:863-514-4984
Practice Address - Fax:863-514-4984
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula