Healthcare Provider Details

I. General information

NPI: 1134066038
Provider Name (Legal Business Name): JEREMIAH JEAN-PHILIPPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 W BROWARD BLVD FL 33324
PLANTATION FL
33324-2404
US

IV. Provider business mailing address

16258 SEA TURTLE PL
WESTLAKE FL
33470-3313
US

V. Phone/Fax

Practice location:
  • Phone: 754-206-7200
  • Fax:
Mailing address:
  • Phone: 954-559-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: