Provider Demographics
NPI:1881332609
Name:JEAN JACQUES, LISE (RN)
Entity type:Individual
Prefix:
First Name:LISE
Middle Name:
Last Name:JEAN JACQUES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 WHIPPOORWILL ROW
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5231
Mailing Address - Country:US
Mailing Address - Phone:786-241-1274
Mailing Address - Fax:
Practice Address - Street 1:740 NE 130TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7527
Practice Address - Country:US
Practice Address - Phone:786-241-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9413465163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical