Beauregard, Jill Rae
Beauregard, Jill Rae is an individual health care provider with primary practice located at 9800 S Healthpark Dr Ste 320 , Fort Myers FL 33908-3630. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Beauregard, Jill Rae can be contacted via phone (239) 343-6350.Contact Information
Primary practice address
9800 S Healthpark Dr Ste 320
Fort Myers FL 33908-3630
Phone: (239) 343-6350
Fax: (239) 343-6358
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 1444 | Tennessee |
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA9110279 | Florida |
Profile Details
| NPI number | 1568546596 |
|---|---|
| LBN Legal business name | Beauregard, Jill Rae |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 25th, 2006 |
| Last updated | Jan 12th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568546596 | NPPES |
| Tennessee | Other | 4336423 | BLUE CROSS/BLUE SHIELD |
| Tennessee | MEDICAID | 102132900 | BLUE CROSS/BLUE SHIELD |
| Tennessee | Other | P01155340 | BLUE CROSS/BLUE SHIELD |
| Tennessee | MEDICAID | 3664999 | BLUE CROSS/BLUE SHIELD |
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