Provider Demographics
NPI:1407484850
Name:JEAN JULIEN, KERLANGE (APRN)
Entity type:Individual
Prefix:
First Name:KERLANGE
Middle Name:
Last Name:JEAN JULIEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8764
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-8764
Mailing Address - Country:US
Mailing Address - Phone:561-880-1503
Mailing Address - Fax:
Practice Address - Street 1:2501 E COMMERCIAL BLVD STE 211
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4127
Practice Address - Country:US
Practice Address - Phone:561-880-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty