Healthcare Provider Details

I. General information

NPI: 1023971983
Provider Name (Legal Business Name): LOUBENTS JEAN BAPTISTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14215 249TH ST
ROSEDALE NY
11422-2143
US

IV. Provider business mailing address

14215 249TH ST
ROSEDALE NY
11422-2143
US

V. Phone/Fax

Practice location:
  • Phone: 352-910-1948
  • Fax:
Mailing address:
  • Phone: 352-910-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN05883-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: