Provider Demographics
NPI:1205005923
Name:BORDELEAU, JUANA (APRN)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:BORDELEAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 SANDY COVE TER
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1112
Mailing Address - Country:US
Mailing Address - Phone:561-229-6189
Mailing Address - Fax:
Practice Address - Street 1:4537 SANDY COVE TER
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1112
Practice Address - Country:US
Practice Address - Phone:561-229-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner