Healthcare Provider Details

I. General information

NPI: 1497667794
Provider Name (Legal Business Name): FIDELE JACQUES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 NE 1ST PL
MIAMI FL
33138-5414
US

IV. Provider business mailing address

PO BOX 741254
BOYNTON BEACH FL
33474-1254
US

V. Phone/Fax

Practice location:
  • Phone: 800-218-1428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: