Healthcare Provider Details

I. General information

NPI: 1235034471
Provider Name (Legal Business Name): PROCARE MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 NW 30TH PL
SUNRISE FL
33323-1623
US

IV. Provider business mailing address

11740 NW 30TH PL
SUNRISE FL
33323-1623
US

V. Phone/Fax

Practice location:
  • Phone: 754-971-9769
  • Fax:
Mailing address:
  • Phone: 754-971-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JEAN BERNARD JULIEN
Title or Position: MBR
Credential:
Phone: 754-971-9769