Search › Florida › 363LF0000X
Jackson Etienne
NPI 1447976071 · on the registry since 2022
Practice
- Address
- 5932 Ne 2nd Ave
Miami, FL 33137 - Phone
- (954) 598-2364
- Organisation at this address
- Providence Community Center Llc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2022-10-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida