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NPI Code Detail

MEDICARE: ALTAGRACE JEAN BAPTISTE

MEDICARE: ALTAGRACE JEAN BAPTISTE
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
1363LF0000XFamily Nurse Practitioner11008785FL

Other Identifiers

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

General Provider Information

NPI Number : 1629682331
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALTAGRACE JEAN BAPTISTE
Provider Business Mailing Address
First Line : 5934 NW DOWELL CT
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34986-3831
Country : US
Telephone Number : 772-359-9187
Fax Number :
Provider Business Practice Location Address
First Line : 1404 S 28TH ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-6999
Country : US
Telephone Number : 772-293-0770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2020
Last Update Date : 03/31/2021

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Directions to “ ALTAGRACE JEAN BAPTISTE ” Practice Location

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