Provider Demographics
NPI:1467909523
Name:ALCIME, JOVENEL
Entity Type:Individual
Prefix:MR
First Name:JOVENEL
Middle Name:
Last Name:ALCIME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 WEST OAKLAND PARK BLVD.
Mailing Address - Street 2:SUITE H
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6588
Mailing Address - Country:US
Mailing Address - Phone:954-366-9865
Mailing Address - Fax:844-478-9719
Practice Address - Street 1:4312 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4829
Practice Address - Country:US
Practice Address - Phone:954-588-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9285051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner