Provider Demographics
NPI:1245726439
Name:JEANTY, JEAN S (APRN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:S
Last Name:JEANTY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16133 NE 8TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4403
Mailing Address - Country:US
Mailing Address - Phone:786-521-9040
Mailing Address - Fax:
Practice Address - Street 1:1450 NW 10TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1011
Practice Address - Country:US
Practice Address - Phone:305-243-6251
Practice Address - Fax:305-243-3506
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9301886363LF0000X
FL9301886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily