Provider Demographics
NPI:1093423618
Name:VEGA LOZADA, CARLOS XAVIER (APRN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:XAVIER
Last Name:VEGA LOZADA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MEADOW POINTE DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-9546
Mailing Address - Country:US
Mailing Address - Phone:787-556-1349
Mailing Address - Fax:
Practice Address - Street 1:2546 SIMPSON ROAD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-632-4217
Practice Address - Fax:407-632-4226
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022209363L00000X
FLAPRN11022209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner