Provider Demographics
NPI:1619403151
Name:JOACHIN, NADEGE (ITDS)
Entity Type:Individual
Prefix:
First Name:NADEGE
Middle Name:
Last Name:JOACHIN
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 SUMTER RD W
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3671
Mailing Address - Country:US
Mailing Address - Phone:561-331-7423
Mailing Address - Fax:
Practice Address - Street 1:928 SUMTER RD W
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3671
Practice Address - Country:US
Practice Address - Phone:561-331-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116794600Medicaid