Individual provider Active NPI

Wisly Jean Baptiste

  • Family Nurse Practitioner
  • Deerfield Beach, FL
National Provider Identifier
1336803345
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11016139 Issued in FL
Practice address
1827 W Hillsboro Blvd
Deerfield Beach, FL 33442-1442
Phone
(954) 800-4054
Fax
(954) 654-7732
NPI assigned
Oct 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11016139 FL Primary

Addresses

Primary practice location

1827 W Hillsboro Blvd
Deerfield Beach, FL 33442-1442

Mailing address

1827 W Hillsboro Blvd
Deerfield Beach, FL 33442-1442
Phone (954) 800-4054

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220228002305 FL Practitioner - Nurse Practitioner 8628462074 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11016139FLMDFamily Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1336803345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1827 W HILLSBORO BLVD",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421442",
            "telephone_number": "954-800-4054",
            "fax_number": "954-654-7732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1827 W HILLSBORO BLVD",
            "city": "DEERFIELD BEACH",
            "state": "FL",
            "postal_code": "334421442",
            "telephone_number": "954-800-4054",
            "fax_number": "954-654-7732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEAN BAPTISTE",
        "first_name": "WISLY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-26",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11016139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deerfield Beach, FL

Sources for this page

Verify at the official NPI Registry.