Provider Demographics
NPI:1902662240
Name:DULAURIER, JEANTILAIR SR (PA)
Entity Type:Individual
Prefix:MRS
First Name:JEANTILAIR
Middle Name:
Last Name:DULAURIER
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11970 NE 16TH AVE
Mailing Address - Street 2:APT 305
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6652
Mailing Address - Country:US
Mailing Address - Phone:786-319-0221
Mailing Address - Fax:
Practice Address - Street 1:11970 NE 16TH AVE APT 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6652
Practice Address - Country:US
Practice Address - Phone:786-319-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ10222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant