Healthcare Provider Details

I. General information

NPI: 1043834666
Provider Name (Legal Business Name): JEUNE&BELLE MEDICAL CENTER AND SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13005 SOUTHERN BLVD STE 214
LOXAHATCHEE FL
33470-9272
US

IV. Provider business mailing address

8987 BIDDLE CT
WELLINGTON FL
33414-6436
US

V. Phone/Fax

Practice location:
  • Phone: 561-254-7933
  • Fax:
Mailing address:
  • Phone: 561-254-7933
  • Fax: 561-254-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BERNADINE C ANDERSON CLARKE
Title or Position: OWNER
Credential: NP
Phone: 561-254-7933