Provider Demographics
NPI:1346892726
Name:BEACHSIDE ADVANCED PRACTICE NURSING LLC
Entity type:Organization
Organization Name:BEACHSIDE ADVANCED PRACTICE NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:321-288-5739
Mailing Address - Street 1:525 ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4385
Mailing Address - Country:US
Mailing Address - Phone:321-288-5739
Mailing Address - Fax:
Practice Address - Street 1:525 ISLAND CT
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4385
Practice Address - Country:US
Practice Address - Phone:321-288-5739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty