Provider Demographics
NPI:1811930720
Name:VINCENTE, JEROME B (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:B
Last Name:VINCENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 JOHN F KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1152
Mailing Address - Country:US
Mailing Address - Phone:561-967-2200
Mailing Address - Fax:
Practice Address - Street 1:115 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1152
Practice Address - Country:US
Practice Address - Phone:561-967-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45602207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259247903Medicaid
FLE34369Medicare UPIN
FL01476Medicare PIN