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General NPI Number Information
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NPI Number | 1063018133
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Entity Type | Individual
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Provider Name | JACKELINE CONDE APRN-BC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 808 SW GLENVIEW CT, SUITES 812 AND 814
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-3495
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Country | US
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Telephone | 772-240-7822
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 SW IMPORT DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-2051
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Country | US
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Telephone | 305-216-1619
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11010147
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License Number State | FL
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