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Active NPI 1114881877 Organization (Entity Type 2)

Beacon Advanced Practice Group Llc

Nurse Practitioner - Family • St Augustine, FL

About Beacon Advanced Practice Group Llc NPI 1114881877 Summary

Beacon Advanced Practice Group Llc is a verified healthcare organization specializing in Nurse Practitioner - Family operating in St Augustine, FL. Located at 335 TAMAR CT, this facility provides patient care and medical services under National Provider Identifier (NPI) 1114881877.

Administrative operations and authorized compliance are overseen by Irina Vella (Owner / Authorized Official).

Facility Location & Contact Primary Location

Facility Address

335 Tamar Ct

St Augustine, FL 320957539

Telephone 9043669981

Fax 6298997995

Authorized Official Information

Authorized Contact Name

Irina Vella , APRN, FNP-BC, WCC

Title / Role

Owner / Authorized Official

Official Telephone

9043669981

Facility Classifications & Specialties

Nurse Practitioner - Family Primary Taxonomy

NUCC Taxonomy Code: 363LF0000X

Definition to come...

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active December 16, 2025

NPI status registered as active in NPPES database

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Updated Practice Location December 16, 2025

Registered at 335 TAMAR CT, ST AUGUSTINE, FL 320957539 (Tel: 9043669981)

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Updated Business Mailing Address December 16, 2025

Registered at 335 TAMAR CT, ST AUGUSTINE, FL 320957539 (Tel: 9043669981)

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Organization / Clinic Name Updated December 16, 2025

Operating as BEACON ADVANCED PRACTICE GROUP LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 16, 2025

Nurse Practitioner

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Initial NPI Registration & Enumeration December 16, 2025

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1114881877

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: December 16, 2025

Last Update: December 16, 2025

Update or Correct Listing

Mailing Address

335 Tamar Ct

St Augustine, FL 320957539

Phone: 9043669981

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.