Healthcare Provider Details

I. General information

NPI: 1598830374
Provider Name (Legal Business Name): MARIE JOCELYNE NICOLAS ALEXANDRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12376 QUAIL ROOST DR
MIAMI FL
33177-4974
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 786-623-0994
  • Fax: 786-430-8197
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-322-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0066935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: