| Beacon Medical LLC | |
|
45 Industrial Blvd Ste C Pensacola FL 32503-7668 | |
| (850) 290-8410 | |
| (866) 574-6391 |
| Full Name | Beacon Medical LLC |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 45 Industrial Blvd Ste C, Pensacola, Florida |
| Authorized Official Name and Position | Karen Jackson (OWNER) |
| Authorized Official Contact | 8502908410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Medical LLC 45 Industrial Blvd Ste C Pensacola FL 32503-7668 Ph: (850) 290-8410 | Beacon Medical LLC 45 Industrial Blvd Ste C Pensacola FL 32503-7668 Ph: (850) 290-8410 |
| NPI Number | 1518468966 |
|---|---|
| Provider Enumeration Date | 02/21/2018 |
| Last Update Date | 06/23/2023 |
| Certification Date | 06/23/2023 |
| Medicare PECOS PAC ID | 5799031969 |
|---|---|
| Medicare Enrollment ID | O20180629001416 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518468966 | NPI | - | NPPES |
| Provider Name | John M Boden |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1417937707 PECOS PAC ID: 0042226912 Enrollment ID: I20060301000699 |
| Provider Name | Karen L Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124274774 PECOS PAC ID: 9638246903 Enrollment ID: I20090520000632 |
| Provider Name | Tiana Natal Nygaard |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1477828614 PECOS PAC ID: 3476713165 Enrollment ID: I20120404000988 |
| Provider Name | Jeremy D Olmstead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508302605 PECOS PAC ID: 7911282561 Enrollment ID: I20170321002560 |
| Provider Name | Crystal L Logsdon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255885604 PECOS PAC ID: 8426327248 Enrollment ID: I20170710001936 |
| Provider Name | Paula Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487250577 PECOS PAC ID: 9133523335 Enrollment ID: I20210810003592 |
| Provider Name | Starla L Saylors |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902495674 PECOS PAC ID: 7416352034 Enrollment ID: I20210819003769 |
| Provider Name | Katrina L Orend |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922727395 PECOS PAC ID: 0042695561 Enrollment ID: I20220920002731 |
| Provider Name | Laura L Holland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972239283 PECOS PAC ID: 8022493360 Enrollment ID: I20220922001182 |
| Provider Name | Christine Marie Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437872728 PECOS PAC ID: 5799161634 Enrollment ID: I20220930000260 |
| Provider Name | James N Byrd |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194815092 PECOS PAC ID: 1254420177 Enrollment ID: I20230307001210 |
| Provider Name | Gretchen Grencer-liegel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467922948 PECOS PAC ID: 3971991357 Enrollment ID: I20240910000221 |
| Provider Name | Ashley Walter Longcrier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598594020 PECOS PAC ID: 2567994650 Enrollment ID: I20241014004042 |
| Provider Name | Virgil Vargas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083583975 PECOS PAC ID: 7012499940 Enrollment ID: I20260228001017 |
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