Individual
NATITA BEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12941 ROYAL GEORGE AVE, ODESSA, FL 33556-5710
(727) 408-4666
Mailing address
12941 ROYAL GEORGE AVE, ODESSA, FL 33556-5710
(727) 408-4666
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
733200
—
FL
Enumeration date
12/11/2018
Last updated
12/11/2018
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