MEDICARE: EMMANUELLE BOUILLIART DE ST SYMPHORIEN

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	11035914	FL

General Provider Information

NPI Number	:	1104646249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUELLE BOUILLIART DE ST SYMPHORIEN

Provider Business Mailing Address
First Line	:	1717 N BAYSHORE DR APT 3251
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-1167
Country	:	US
Telephone Number	:	305-965-8859
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 N BAYSHORE DR APT 3251
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-1167
Country	:	US
Telephone Number	:	305-965-8859
Fax Number	:

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

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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Directions to “ EMMANUELLE BOUILLIART DE ST SYMPHORIEN ” Practice Location

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