Provider Demographics
NPI:1356002554
Name:JEAN PIERRE, JOANE SUZE
Entity Type:Individual
Prefix:
First Name:JOANE
Middle Name:SUZE
Last Name:JEAN PIERRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANE
Other - Middle Name:SUZE
Other - Last Name:GRISPAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 471142
Mailing Address - Street 2:
Mailing Address - City:LAKE MONROE
Mailing Address - State:FL
Mailing Address - Zip Code:32747-1142
Mailing Address - Country:US
Mailing Address - Phone:239-745-0941
Mailing Address - Fax:
Practice Address - Street 1:1522 OLD ENGLAND LOOP
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6584
Practice Address - Country:US
Practice Address - Phone:239-745-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238159374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty