Healthcare Provider Details

I. General information

NPI: 1588020010
Provider Name (Legal Business Name): JEAN-CLAUDE CREVECOEUR ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 NW 95TH ST
MIAMI FL
33150-2063
US

IV. Provider business mailing address

15812 SW 24TH ST
MIRAMAR FL
33027-4267
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-6140
  • Fax:
Mailing address:
  • Phone: 954-235-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9295984
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9295984
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberARNP9295984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: