Healthcare Provider Details

I. General information

NPI: 1417339284
Provider Name (Legal Business Name): ANNA JUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

IV. Provider business mailing address

1309 N FLAGLER DR
WEST PALM BEACH FL
33401-3406
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-4541
  • Fax: 561-650-6093
Mailing address:
  • Phone: 561-882-4541
  • Fax: 561-650-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2921212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: