Healthcare Provider Details

I. General information

NPI: 1043620446
Provider Name (Legal Business Name): HENRY JOVANY JEAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

500 SE OSCEOLA ST
STUART FL
34994-2364
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-5200
  • Fax:
Mailing address:
  • Phone: 772-286-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME127093
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME127093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: