Basic Information
| Provider Information | |||||||||
| NPI: | 1730532672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEANA MARIE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17345 SW 8TH ST | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330294210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547321222 | ||||||||
| FaxNumber: | 9544306140 | ||||||||
| Practice Location | |||||||||
| Address1: | 5352 LINTON BLVD | ||||||||
| Address2: | DELRAY MEDICAL CENTER | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614984440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | HEINZ | ||||||||
| AuthorizedOfficialFirstName: | JEANA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9547321222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.