MEDICARE: MR. JEAN BERNARD FLEURISTAL

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	ARNP9162372	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447609094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN BERNARD FLEURISTAL

Provider Business Mailing Address
First Line	:	47 5TH ST NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4672
Country	:	US
Telephone Number	:	863-268-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 INGRAHAM AVE
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4327
Country	:	US
Telephone Number	:	866-234-8534
Fax Number	:

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

Provider Enumeration Date	:	06/05/2016
Last Update Date	:	08/31/2022

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