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General NPI Number Information
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NPI Number | 1679436612
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Entity Type | Individual
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Provider Name | ROSE GUERDINE JEANTY
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 912 SE THORNHILL DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-4056
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Country | US
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Telephone | 561-503-1238
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Fax | 561-503-1238
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Provider Business Mailing Address
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Address Line | 912 SE THORNHILL DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-4056
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Country | US
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Telephone | 561-503-1238
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Fax | 561-503-1238
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN9666297
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License Number State | FL
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