Provider Demographics
NPI:1730558537
Name:BEACH CARE PLLC
Entity type:Organization
Organization Name:BEACH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZULO
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:305-801-1045
Mailing Address - Street 1:1000 5TH ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6508
Mailing Address - Country:US
Mailing Address - Phone:681-222-7348
Mailing Address - Fax:
Practice Address - Street 1:1000 5TH ST
Practice Address - Street 2:SUITE 409
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6508
Practice Address - Country:US
Practice Address - Phone:681-222-7348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9220338363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty