Basic Information
| Provider Information | |||||||||
| NPI: | 1659736767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEAN | ||||||||
| FirstName: | HARRY | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 JFK DR | ||||||||
| Address2: | STE B | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619667717 | ||||||||
| FaxNumber: | 8883162198 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 HEALTH PARK DR | ||||||||
| Address2: | |||||||||
| City: | MOORE HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334716206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8639460405 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2015 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 9385232 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.