Individual
KRISTINA LESLIE MIRABEAU-BEALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
820 GOODLETTE RD N, NAPLES, FL 34102-5445
(239) 434-0166
(239) 434-7553
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
244570
MA
2085R0001X
Radiation Oncology Physician
253714
MA
2085R0001X
Radiation Oncology Physician
Primary
ME124523
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015685200
—
FL
01
—
1256802
WELLCARE
FL
01
—
151A9
BCBS
FL
01
—
3367095
CIGNA
FL
01
—
384979
AVMED
FL
01
—
4707733
AETNA
FL
01
—
P01550908
RR MEDICARE
FL
01
—
P1037533
FREEDOM
FL
01
—
P972757
OPTIMUM
FL
Enumeration date
06/02/2010
Last updated
11/18/2016
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