Provider Demographics
NPI:1962972562
Name:JEAN LOUIS, IRMA (CNA)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:JEAN LOUIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 COLLEGE CT APT 203
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7164
Mailing Address - Country:US
Mailing Address - Phone:954-394-9218
Mailing Address - Fax:954-999-0522
Practice Address - Street 1:6885 COLLEGE CT APT 203
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7164
Practice Address - Country:US
Practice Address - Phone:954-394-9218
Practice Address - Fax:954-999-0522
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide