Provider Demographics
NPI:1871303776
Name:FRIED, JOLEE-TYLER RACHEL
Entity type:Individual
Prefix:
First Name:JOLEE-TYLER
Middle Name:RACHEL
Last Name:FRIED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 COUNTRY LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-5726
Mailing Address - Country:US
Mailing Address - Phone:973-570-4921
Mailing Address - Fax:
Practice Address - Street 1:2723 COUNTRY LAKE TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-5726
Practice Address - Country:US
Practice Address - Phone:973-570-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily