Provider Demographics
NPI:1336803345
Name:JEAN BAPTISTE, WISLY
Entity Type:Individual
Prefix:
First Name:WISLY
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1442
Mailing Address - Country:US
Mailing Address - Phone:954-800-4054
Mailing Address - Fax:954-654-7732
Practice Address - Street 1:1827 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1442
Practice Address - Country:US
Practice Address - Phone:954-800-4054
Practice Address - Fax:954-654-7732
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily