Provider Demographics
NPI:1306418264
Name:NAVAS, JUAN CARLOS (APRN)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:NAVAS
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 1:2970 W 84TH ST UNIT 6&7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4917
Mailing Address - Country:US
Mailing Address - Phone:305-828-4983
Mailing Address - Fax:305-820-8350
Practice Address - Street 1:2970 W 84TH ST UNIT 6&7
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4917
Practice Address - Country:US
Practice Address - Phone:305-828-4983
Practice Address - Fax:305-820-8350
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06212562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF06212562OtherAPRN LICENSE