Healthcare Provider Details

I. General information

NPI: 1710975388
Provider Name (Legal Business Name): LETICIA B JEANNERET ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6738
US

IV. Provider business mailing address

4620 N STATE ROAD 7 STE 316
LAUDERDALE LAKES FL
33319-5884
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-3255
  • Fax: 954-941-7797
Mailing address:
  • Phone: 954-967-6400
  • Fax: 954-967-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberARNP3262702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: