Provider Demographics
NPI:1760267207
Name:JEAN, MARVENS (APRN)
Entity type:Individual
Prefix:
First Name:MARVENS
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 W SAMPLE ROAD
Mailing Address - Street 2:SUITE 322
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1342
Mailing Address - Country:US
Mailing Address - Phone:954-481-9942
Mailing Address - Fax:954-481-9917
Practice Address - Street 1:2001 W SAMPLE ROAD
Practice Address - Street 2:SUITE 322
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1342
Practice Address - Country:US
Practice Address - Phone:954-481-9942
Practice Address - Fax:954-481-9917
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027872363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care