MEDICARE: ISLANDE JEUNE NP

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	363L00000X	Nurse Practitioner	APRN-NP163860	GA

General Provider Information

NPI Number	:	1699362533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISLANDE JEUNE NP

Provider Business Mailing Address
First Line	:	4223 HIGHWAY 42
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-2141
Country	:	US
Telephone Number	:	770-995-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 HIGHWAY 42
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-2141
Country	:	US
Telephone Number	:	470-395-6793
Fax Number	:

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

Provider Enumeration Date	:	12/27/2020
Last Update Date	:	10/29/2025

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