Provider Demographics
NPI:1083243604
Name:DELVA, JEAN BAPTISTE (PA)
Entity Type:Individual
Prefix:
First Name:JEAN BAPTISTE
Middle Name:
Last Name:DELVA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 SNOWY EGRET LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6003 SNOWY EGRET LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-1528
Practice Address - Country:US
Practice Address - Phone:561-635-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000372-P.A.363A00000X
FLTPPA633363A00000X
AZ10183363A00000X
FLHSE30167208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant