Provider Demographics
NPI:1396438263
Name:JEAN BAPTISTE, ANGENIE
Entity type:Individual
Prefix:
First Name:ANGENIE
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 1ST AVE # 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4808
Mailing Address - Country:US
Mailing Address - Phone:305-884-4110
Mailing Address - Fax:
Practice Address - Street 1:300 E 1ST AVE # 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4808
Practice Address - Country:US
Practice Address - Phone:305-884-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1719363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty