Provider Demographics
NPI:1346630092
Name:JEAN, MARIE MARLENE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIE MARLENE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16404 VALENCIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2705
Mailing Address - Country:US
Mailing Address - Phone:561-358-9151
Mailing Address - Fax:
Practice Address - Street 1:16404 VALENCIA BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-2705
Practice Address - Country:US
Practice Address - Phone:561-358-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9168781363LF0000X
FL9168781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily