Provider Demographics
NPI:1720414394
Name:JEAN L TRESCOTT PHD RN PA
Entity Type:Organization
Organization Name:JEAN L TRESCOTT PHD RN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-772-0924
Mailing Address - Street 1:1044 S NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1315
Mailing Address - Country:US
Mailing Address - Phone:305-772-0924
Mailing Address - Fax:954-920-0925
Practice Address - Street 1:1031 IVES DAIRY RD
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2538
Practice Address - Country:US
Practice Address - Phone:305-772-0924
Practice Address - Fax:954-920-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4780103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty