Provider Demographics
NPI:1902614837
Name:ALFRED, JEAN EMILIANO (NP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:EMILIANO
Last Name:ALFRED
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 CENTERRA LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7986
Mailing Address - Country:US
Mailing Address - Phone:845-821-2135
Mailing Address - Fax:
Practice Address - Street 1:2292 CENTERRA LOOP
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7986
Practice Address - Country:US
Practice Address - Phone:845-821-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036238363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care