Provider Demographics
NPI:1588214522
Name:ST FLEUR, JUNA DANASTOR
Entity Type:Individual
Prefix:
First Name:JUNA
Middle Name:DANASTOR
Last Name:ST FLEUR
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 1:272 LAKE MONTEREY CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8442
Mailing Address - Country:US
Mailing Address - Phone:954-471-1201
Mailing Address - Fax:
Practice Address - Street 1:272 LAKE MONTEREY CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8442
Practice Address - Country:US
Practice Address - Phone:954-471-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9339188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS314424796030OtherLICENSE