Provider Demographics
NPI:1730786708
Name:JEAN, MURIELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MURIELLE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4963 SW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4903
Mailing Address - Country:US
Mailing Address - Phone:305-297-6311
Mailing Address - Fax:
Practice Address - Street 1:4963 SW 166TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4903
Practice Address - Country:US
Practice Address - Phone:305-297-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0Medicaid
FL05Medicaid
FL966057Medicaid
FL10022020003759Medicaid