Provider Demographics
NPI:1255501433
Name:JEAN, MARIE ALBERTE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ALBERTE
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 1:5513 NW THYER CIR
Mailing Address - Street 2:350 SW GRIMALDO TER
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3331
Mailing Address - Country:US
Mailing Address - Phone:772-260-4993
Mailing Address - Fax:
Practice Address - Street 1:5513 NW THYER CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:772-260-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health