Provider Demographics
NPI:1770259939
Name:ETIENNE, PASCALE LAMOTHE
Entity type:Individual
Prefix:
First Name:PASCALE
Middle Name:LAMOTHE
Last Name:ETIENNE
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 1:13311 SW 108TH STREET CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3423
Mailing Address - Country:US
Mailing Address - Phone:305-510-4554
Mailing Address - Fax:
Practice Address - Street 1:13311 SW 108TH STREET CIR # A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3423
Practice Address - Country:US
Practice Address - Phone:305-510-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9297371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty