Provider Demographics
NPI:1720815590
Name:PALMER, JERMAINE DEWAYNE (APRN)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:DEWAYNE
Last Name:PALMER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 NW 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4024
Mailing Address - Country:US
Mailing Address - Phone:754-368-9828
Mailing Address - Fax:
Practice Address - Street 1:315 NW 109TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4024
Practice Address - Country:US
Practice Address - Phone:754-368-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9273763207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine