Healthcare Provider Details

I. General information

NPI: 1881415123
Provider Name (Legal Business Name): BERTINE JEAN LAURENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 E SEMORAN BLVD STE 264
APOPKA FL
32703-5953
US

IV. Provider business mailing address

3030 E SEMORAN BLVD STE 264
APOPKA FL
32703-5953
US

V. Phone/Fax

Practice location:
  • Phone: 321-280-3810
  • Fax:
Mailing address:
  • Phone: 321-280-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number359149
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035690
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP70087650
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number336328
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: