Healthcare Provider Details

I. General information

NPI: 1740804178
Provider Name (Legal Business Name): JARDIN DEDEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11830 NW 25TH STREET
PLANTATION FL
33323-1702
US

IV. Provider business mailing address

11830 NW 25TH STREET
PLANTATION FL
33323-1702
US

V. Phone/Fax

Practice location:
  • Phone: 754-252-6690
  • Fax: 800-574-5053
Mailing address:
  • Phone: 754-252-6690
  • Fax: 800-574-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AURELIE DORICENT
Title or Position: OWNER
Credential: NP
Phone: 754-252-6690