MEDICARE: JULIE VICTORIN JEANJACQUES

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	364SF0001X	Family Health Clinical Nurse Specialist	12250004	FL

General Provider Information

NPI Number	:	1831054030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE VICTORIN JEANJACQUES

Provider Business Mailing Address
First Line	:	12150 SW 249TH LN
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-6046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12150 SW 249TH LN
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-6046
Country	:	US
Telephone Number	:	305-439-8913
Fax Number	:

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

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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