Provider Demographics
NPI:1922610971
Name:ETIENNE, MARIE MYLENE (DNP, FNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MYLENE
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 RESTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6110
Mailing Address - Country:US
Mailing Address - Phone:561-929-6581
Mailing Address - Fax:
Practice Address - Street 1:2054 VISTA PKWY STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6742
Practice Address - Country:US
Practice Address - Phone:561-246-4101
Practice Address - Fax:561-246-4377
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008783363LF0000X
FLAPRN11008783363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily