Provider Demographics
NPI:1487252417
Name:REAUME, JANICE (APRN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:REAUME
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 1:3335 IMPERIAL MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-5519
Mailing Address - Country:US
Mailing Address - Phone:863-251-4655
Mailing Address - Fax:
Practice Address - Street 1:3335 IMPERIAL MANOR WAY
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-5519
Practice Address - Country:US
Practice Address - Phone:863-251-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009889207N00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology