Provider Demographics
NPI:1801133970
Name:BEACH, CAITLIN (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:8250 BRYAN DAIRY RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1360
Practice Address - Country:US
Practice Address - Phone:727-393-5300
Practice Address - Fax:727-393-5301
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2019-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant