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Individual
MR. JACOB CODY BEACH
Active
Individual
MR. JACOB CODY BEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN,APRN,FNP-C, CEN
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
0001238176
VA
363L00000X
Nurse Practitioner
Primary
0024177331
VA
Other
Enumeration date
06/20/2014
Last updated
07/25/2022
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