Basic Information
| Provider Information | |||||||||
| NPI: | 1295471217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMILE | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 N LAUREL DR APT 2A | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330635316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543267244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 818 S DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334605042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612964400 | ||||||||
| FaxNumber: | 5619092075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2022 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11019624 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.