Provider Demographics
NPI:1861191124
Name:JN PIERRE METELLUS, MARIE DENISE (APRN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:DENISE
Last Name:JN PIERRE METELLUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 WELLCRAFT DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5972
Mailing Address - Country:US
Mailing Address - Phone:561-293-1833
Mailing Address - Fax:
Practice Address - Street 1:5419 WELLCRAFT DR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5972
Practice Address - Country:US
Practice Address - Phone:561-293-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2022137473OtherANCC
FL11024889OtherBOARD OF NURSING