Provider Demographics
NPI:1023065083
Name:EMANUEL, GERALDINE BRANDEFINE (ARNP)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:BRANDEFINE
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 PGA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2910
Mailing Address - Country:US
Mailing Address - Phone:561-693-0540
Mailing Address - Fax:561-694-9064
Practice Address - Street 1:600 VILLAGE SQUARE XING
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4542
Practice Address - Country:US
Practice Address - Phone:561-694-9493
Practice Address - Fax:561-694-9064
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1962842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ35112Medicare UPIN
FLU4171WMedicare ID - Type Unspecified
FLU4171YMedicare ID - Type Unspecified
FLQ35112Medicare UPIN
FLU4171VMedicare ID - Type Unspecified
FLU4171ZMedicare ID - Type Unspecified