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Individual

JASON BEAU DELUISA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ANP,CNP, APRN

Contact information

Practice address
1577 C ST, ANCHORAGE, AK 99501-5127
(941) 348-6927
(907) 865-2433
Mailing address
15919 29TH ST E, PARRISH, FL 34219-1854
(505) 331-0295
(907) 865-2433

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
117659
AK
363LF0000X
Family Nurse Practitioner
CNP-01518
NM
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
117659
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1666771
AK
05
37805771
NM
Enumeration date
08/20/2009
Last updated
02/01/2025
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