Provider Demographics
NPI:1023536802
Name:JEAN, GERLYNE
Entity Type:Individual
Prefix:
First Name:GERLYNE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BRYNMAR ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-6027
Mailing Address - Country:US
Mailing Address - Phone:407-401-1353
Mailing Address - Fax:
Practice Address - Street 1:901 BRYNMAR ESTATES BLVD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6027
Practice Address - Country:US
Practice Address - Phone:407-401-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSSC
$$$$$$$$$OtherSSC