Provider Demographics
NPI:1952191199
Name:DORFEUILLE, JEAN RENALD (PMHNP)
Entity type:Individual
Prefix:MR
First Name:JEAN RENALD
Middle Name:
Last Name:DORFEUILLE
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3194 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8003
Mailing Address - Country:US
Mailing Address - Phone:561-900-6265
Mailing Address - Fax:
Practice Address - Street 1:5975 W SUNRISE BLVD STE 119
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6800
Practice Address - Country:US
Practice Address - Phone:954-368-6856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9437644363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health