Provider Demographics
NPI:1639711096
Name:JEAN LAURENT, MARGARETTE
Entity Type:Individual
Prefix:
First Name:MARGARETTE
Middle Name:
Last Name:JEAN LAURENT
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 1:261 SW FAIRCHILD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4908
Mailing Address - Country:US
Mailing Address - Phone:954-213-7914
Mailing Address - Fax:772-877-3971
Practice Address - Street 1:261 SW FAIRCHILD AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4908
Practice Address - Country:US
Practice Address - Phone:954-213-7914
Practice Address - Fax:772-877-3971
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-1689172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker