Provider Demographics
NPI:1457169450
Name:JEROME, MARTINE (PMHNP)
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:JEROME
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 SUNRISE LAKES BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2165
Mailing Address - Country:US
Mailing Address - Phone:443-527-2415
Mailing Address - Fax:
Practice Address - Street 1:1900 N BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3001
Practice Address - Country:US
Practice Address - Phone:888-947-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036743363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health