Provider Demographics
NPI:1568234573
Name:JOLICOEUR, SEBASTIEN (APRN)
Entity Type:Individual
Prefix:
First Name:SEBASTIEN
Middle Name:
Last Name:JOLICOEUR
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW 124TH TER APT 203
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4068
Mailing Address - Country:US
Mailing Address - Phone:954-381-6597
Mailing Address - Fax:
Practice Address - Street 1:1300 SW 124TH TER APT 203
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-4068
Practice Address - Country:US
Practice Address - Phone:954-381-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily