Provider Demographics
NPI:1780703793
Name:CONDE, JANNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:JANNETTE
Middle Name:
Last Name:CONDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 400
Mailing Address - Street 2:
Mailing Address - City:COTOPAXI
Mailing Address - State:CO
Mailing Address - Zip Code:81223-0400
Mailing Address - Country:US
Mailing Address - Phone:719-285-5121
Mailing Address - Fax:719-218-9994
Practice Address - Street 1:1601 N. PALM AVE
Practice Address - Street 2:STE 303
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3242
Practice Address - Country:US
Practice Address - Phone:888-852-6672
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1025652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000592200Medicaid
FLBI294ZMedicare PIN