MEDICARE: JACQUES D TELFORT

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	163W00000X	Registered Nurse	9676558	FL

General Provider Information

NPI Number	:	1174472906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUES D TELFORT

Provider Business Mailing Address
First Line	:	2441 SW FALCON CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2923
Country	:	US
Telephone Number	:	516-744-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 SW FALCON CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2923
Country	:	US
Telephone Number	:	516-744-9838
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	02/08/2026

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