Provider Demographics
NPI:1699362533
Name:JEUNE, ISLANDE (NP)
Entity Type:Individual
Prefix:
First Name:ISLANDE
Middle Name:
Last Name:JEUNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ISLANDE
Other - Middle Name:
Other - Last Name:JEUNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4223 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-2141
Mailing Address - Country:US
Mailing Address - Phone:770-995-1500
Mailing Address - Fax:
Practice Address - Street 1:4223 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-2141
Practice Address - Country:US
Practice Address - Phone:404-663-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner