Provider Demographics
NPI:1629000336
Name:GAETANO, JEAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:GAETANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4207
Mailing Address - Country:US
Mailing Address - Phone:315-601-4375
Mailing Address - Fax:407-201-7818
Practice Address - Street 1:141 N 6TH ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4207
Practice Address - Country:US
Practice Address - Phone:315-601-4375
Practice Address - Fax:407-201-7818
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9496896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02805172Medicaid
NYJ400037001Medicare PIN
S32431Medicare UPIN
NYJ400007150Medicare PIN