Basic Information
| Provider Information | |||||||||
| NPI: | 1679033534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FABRICANT | ||||||||
| FirstName: | JAIMIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5848 WEST ATLANTIC AVE SUITE 143 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334841217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612706950 | ||||||||
| FaxNumber: | 5614044028 | ||||||||
| Practice Location | |||||||||
| Address1: | 5848 WEST ATLANTIC AVE SUITE 143 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334841217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612706950 | ||||||||
| FaxNumber: | 5614044028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2019 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS19266 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.