Provider Demographics
NPI:1639541725
Name:SENEQUE, RENETTE
Entity Type:Individual
Prefix:
First Name:RENETTE
Middle Name:
Last Name:SENEQUE
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 1:2590 E ARAGON BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-8063
Mailing Address - Country:US
Mailing Address - Phone:954-663-8962
Mailing Address - Fax:
Practice Address - Street 1:2590 E ARAGON BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-8063
Practice Address - Country:US
Practice Address - Phone:954-663-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9304355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily