Provider Demographics
NPI:1689049041
Name:JEAN, REYNALD (ARNP)
Entity Type:Individual
Prefix:
First Name:REYNALD
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15281 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3608
Mailing Address - Country:US
Mailing Address - Phone:954-662-5286
Mailing Address - Fax:
Practice Address - Street 1:8175 NW 12TH ST STE 306
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126
Practice Address - Country:US
Practice Address - Phone:786-845-0164
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9281306163W00000X
FL9281306363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse