Provider Demographics
NPI:1477065746
Name:MYRTHIL, JEAN-ROBERT (ARNP)
Entity type:Individual
Prefix:
First Name:JEAN-ROBERT
Middle Name:
Last Name:MYRTHIL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LUCIEN WAY STE 1000
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7003
Mailing Address - Country:US
Mailing Address - Phone:407-875-0028
Mailing Address - Fax:
Practice Address - Street 1:2201 LUCIEN WAY STE 1000
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7003
Practice Address - Country:US
Practice Address - Phone:407-875-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9179887363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology