MEDICARE: ROGER CHARLES DAVID JACQUES A.R.N.P.

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	9358447	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	9358447	FL

General Provider Information

NPI Number	:	1518362870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER CHARLES DAVID JACQUES A.R.N.P.

Provider Business Mailing Address
First Line	:	308 NW 5TH AVE
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-2568
Country	:	US
Telephone Number	:	863-261-8354
Fax Number	:	786-221-4107

Provider Business Practice Location Address
First Line	:	950NE182ND TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1163
Country	:	US
Telephone Number	:	347-483-9435
Fax Number	:

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

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	11/30/2023

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