| Jacqueline Boutrouille Md Pa | |
|
7880 N University Dr Ste 303 Tamarac FL 33321-2124 | |
| (954) 340-3000 | |
| (954) 636-8407 |
| Full Name | Jacqueline Boutrouille Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 7880 N University Dr, Tamarac, Florida |
| Authorized Official Name and Position | Jacqueline D Boutrouille (OWNER) |
| Authorized Official Contact | 9543403000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline Boutrouille Md Pa 7880 N University Dr Ste 303 Tamarac FL 33321-2124 Ph: (954) 340-3000 | Jacqueline Boutrouille Md Pa 7880 N University Dr Ste 303 Tamarac FL 33321-2124 Ph: (954) 340-3000 |
| NPI Number | 1720325574 |
|---|---|
| Provider Enumeration Date | 01/14/2013 |
| Last Update Date | 03/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720325574 | NPI | - | NPPES |
| 268083100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME87029 (Florida) | Primary |
| 2084P0802X | Psychiatry & Neurology - Addiction Psychiatry | ME87029 (Florida) | Secondary |
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