Provider Demographics
NPI:1184359390
Name:RENDEL, JEAN-JOSEPH GANEAU JR (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:JEAN-JOSEPH
Middle Name:GANEAU
Last Name:RENDEL
Suffix:JR
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 ARELIA DR S
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-5734
Mailing Address - Country:US
Mailing Address - Phone:561-843-7604
Mailing Address - Fax:
Practice Address - Street 1:14236 TAMIAMI TRL STE B
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2228
Practice Address - Country:US
Practice Address - Phone:941-200-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184359390Medicaid