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General NPI Number Information
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NPI Number | 1063234938
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Entity Type | Individual
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Provider Name | SOPHIA ETIENNE-JEAN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 7859 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-3225
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Country | US
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Telephone | 561-264-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 10342 MEDICIS PL
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City | WELLINGTON
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State | FL
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Zip | 33449-8068
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Country | US
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Telephone | 786-369-6505
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95037304
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11034245
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License Number State | FL
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