Basic Information
| Provider Information | |||||||||
| NPI: | 1255891362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEJEAN | ||||||||
| FirstName: | SERGENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5273 SW 121ST TER | ||||||||
| Address2: | |||||||||
| City: | COOPER CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333304279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053369360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 NW 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056895881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2019 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 9274321 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 363L00000X | APRN9274321 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.