Healthcare Provider Details

I. General information

NPI: 1669700811
Provider Name (Legal Business Name): VENETTE PIERRE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S JEFFERSON ST
PERRY FL
32348-5611
US

IV. Provider business mailing address

1702 S JEFFERSON ST
PERRY FL
32348-5611
US

V. Phone/Fax

Practice location:
  • Phone: 855-577-5437
  • Fax: 850-838-2140
Mailing address:
  • Phone: 855-577-5437
  • Fax: 850-838-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4946
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11618
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: