| Miracleclinic | |
|
2006 Reston Cir Royal Palm Beach FL 33411-6110 | |
| (156) 192-9658 | |
| Not Available |
| Full Name | Miracleclinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2006 Reston Cir, Royal Palm Beach, Florida |
| Authorized Official Name and Position | Marie Etienne (FNP) |
| Authorized Official Contact | 5619296581 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracleclinic 2006 Reston Cir Royal Palm Beach FL 33411-6110 Ph: (156) 192-9658 | Miracleclinic 2006 Reston Cir Royal Palm Beach FL 33411-6110 Ph: (156) 192-9658 |
| NPI Number | 1841908019 |
|---|---|
| Provider Enumeration Date | 11/07/2022 |
| Last Update Date | 11/07/2022 |
| Medicare PECOS PAC ID | 2062880982 |
|---|---|
| Medicare Enrollment ID | O20221128001916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841908019 | NPI | - | NPPES |
| 1922610971 | Other | FL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Marie Mylene Etienne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922610971 PECOS PAC ID: 6507234424 Enrollment ID: I20221128002155 |
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