Provider Demographics
NPI:1043823644
Name:DAWSON, JOSE RUBEN ALDO (NP-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RUBEN ALDO
Last Name:DAWSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 SW MUNJACK CV
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4530
Mailing Address - Country:US
Mailing Address - Phone:832-348-3707
Mailing Address - Fax:
Practice Address - Street 1:656 SW MUNJACK CV
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4530
Practice Address - Country:US
Practice Address - Phone:832-348-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner