MEDICARE: MARIE MYLENE ETIENNE DNP, FNP

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	11008783	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11008783	FL

General Provider Information

NPI Number	:	1922610971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE MYLENE ETIENNE DNP, FNP

Provider Business Mailing Address
First Line	:	9121 N MILITARY TRL STE 111
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5985
Country	:	US
Telephone Number	:	561-626-7604
Fax Number	:	877-266-6973

Provider Business Practice Location Address
First Line	:	9121 N MILITARY TRL STE 111
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5985
Country	:	US
Telephone Number	:	561-626-7604
Fax Number	:	877-266-6973

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

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	01/07/2026

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