MEDICARE: JESULA SAINT LOUIS 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	363LF0000X	Family Nurse Practitioner	11032543	FL

General Provider Information

NPI Number	:	1063244804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESULA SAINT LOUIS APRN

Provider Business Mailing Address
First Line	:	4756 NW 14TH ST
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-3959
Country	:	US
Telephone Number	:	786-260-9279
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3229
Country	:	US
Telephone Number	:	754-888-5656
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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