JEANIACIEUSE THEODORE NPI 1285450155

NPI Information

  • NPI: 1285450155
  • Provider Name: JEANIACIEUSE THEODORE
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1801 SE HILLMOOR DR STE C104C103
    PORT SAINT LUCIE, FL
    ZIP 34952
  • Phone: (772) 742-2111

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NPI Details

Jeaniacieuse Theodore is a family nurse practitioner in Port Saint Lucie, FL with 2 years of experience. Jeaniacieuse Theodore NPI is 1285450155. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1801 SE HILLMOOR DR STE C104C103
PORT SAINT LUCIE, FL
ZIP 34952-553
Phone: (772) 742-2111

The NPI 1285450155 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/25/2024 and was last updated on 1/23/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily11036138FLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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