Provider Demographics
NPI:1154300606
Name:FILS, JEANNE ROSELIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ROSELIE
Last Name:FILS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1816
Mailing Address - Country:US
Mailing Address - Phone:954-465-8691
Mailing Address - Fax:
Practice Address - Street 1:1099 BIRCHWOOD RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1816
Practice Address - Country:US
Practice Address - Phone:954-465-8691
Practice Address - Fax:305-945-6191
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2751942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y071YOtherBLUE CROSS BLUE SHIELD
FL306987700Medicaid
P00312470OtherRAILROAD MEDICARE
FLE4257Medicare PIN
P00312470OtherRAILROAD MEDICARE