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General NPI Number Information
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NPI Number | 1710487103
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Entity Type | Individual
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Provider Name | JENINE LOUISE CONRAD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 600 W HILLSBORO BLVD STE 10
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-1609
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Country | US
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Telephone | 186-644-8771
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Fax | 954-596-4746
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Provider Business Mailing Address
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Address Line | 5615 BARBARY COAST DR
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City | NEW BERN
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State | NC
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Zip | 28560-9708
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Country | US
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Telephone | 434-953-6860
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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 | 0024175628
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License Number State | VA
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