Provider Demographics
NPI:1992063267
Name:BEASLEY, JENNA (MD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6202 N 9TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8291
Mailing Address - Country:US
Mailing Address - Phone:508-888-2424
Mailing Address - Fax:620-710-7703
Practice Address - Street 1:6202 N 9TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8291
Practice Address - Country:US
Practice Address - Phone:850-888-2424
Practice Address - Fax:620-710-7703
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118808207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology