Provider Demographics
NPI:1114354032
Name:JCE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:JCE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:COQUELET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-466-8884
Mailing Address - Street 1:PO BOX 13450
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34979-3450
Mailing Address - Country:US
Mailing Address - Phone:772-466-8884
Mailing Address - Fax:772-466-8832
Practice Address - Street 1:4640 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5057
Practice Address - Country:US
Practice Address - Phone:772-466-8884
Practice Address - Fax:772-466-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6690261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care