MEDICARE: JESULA JEROME ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP1920062	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770881609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESULA JEROME ARNP

Provider Business Mailing Address
First Line	:	PO BOX 198054
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8054
Country	:	US
Telephone Number	:	786-573-6894
Fax Number	:

Provider Business Practice Location Address
First Line	:	6855 S RED RD STE 600
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3518
Country	:	US
Telephone Number	:	786-243-8132
Fax Number	:	786-243-8010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	05/01/2019

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