MEDICARE: REMI DIEUJUSTE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11024111	FL

General Provider Information

NPI Number	:	1003522236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMI DIEUJUSTE APRN

Provider Business Mailing Address
First Line	:	1803 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4747
Country	:	US
Telephone Number	:	772-666-1801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5364
Country	:	US
Telephone Number	:	772-666-1801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	08/06/2024

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