Jackson Etienne

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F09220203 Issued in FL

Practice address

5932 NE 2ND Ave
Miami, FL 33137-2010

Phone

(954) 598-2364

NPI assigned

Oct 14, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jackson.etienne@451.emedpractice.direct-ci.com

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

{
    "created_epoch": "1665705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1447976071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2881 NW 68TH LN",
            "city": "MARGATE",
            "state": "FL",
            "postal_code": "330632041",
            "telephone_number": "305-834-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5932 NE 2ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331372010",
            "telephone_number": "954-598-2364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "JACKSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-14",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "F09220203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethereal Medspa LLC
• Ethereal Medspa LLC
• Ethos Behavioral Therapy LLC
• Ethan Etiel
• Yosef Etiel
• Jansie Etienne, ARNP
• Kanson Etienne
• Pascale Lamothe Etienne
• Santcha Etienne
• Tamara Esther Etienne

• Family Nurse Practitioner in Miami, FL
• Providers in Miami, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.