Provider Demographics
NPI:1609029719
Name:AUDETTE, JOSEPH PAUL
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:AUDETTE
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 1:15089 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1005
Mailing Address - Country:US
Mailing Address - Phone:954-298-9241
Mailing Address - Fax:
Practice Address - Street 1:15089 JAMAICA DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-1005
Practice Address - Country:US
Practice Address - Phone:954-298-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA20169171M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator