Individual
JENNA R BEAULIEU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
2260 W OLD US HIGHWAY 441 STE 314, MOUNT DORA, FL 32757-3508
(321) 529-1933
Mailing address
PO BOX 314, MOUNT DORA, FL 32756-0314
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9435789
FL
163WH0200X
Home Health Registered Nurse
9435789
FL
163WP0808X
Psychiatric/Mental Health Registered Nurse
9435789
FL
Other
Enumeration date
03/08/2021
Last updated
08/30/2021
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