Provider Demographics
NPI:1386771921
Name:BEAZLEY, JANICE EILEEN (PA)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:EILEEN
Last Name:BEAZLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-1405
Mailing Address - Country:US
Mailing Address - Phone:860-412-0086
Mailing Address - Fax:
Practice Address - Street 1:100 WELLS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2928
Practice Address - Country:US
Practice Address - Phone:860-249-4466
Practice Address - Fax:860-249-4469
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000389363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical