Provider Demographics
NPI:1346317856
Name:AMADO, JUAN A (ARNP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:AMADO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 STATE ROAD 7
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4615
Mailing Address - Country:US
Mailing Address - Phone:561-753-7487
Mailing Address - Fax:561-273-2331
Practice Address - Street 1:5065 STATE ROAD 7
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-4615
Practice Address - Country:US
Practice Address - Phone:561-753-7487
Practice Address - Fax:561-273-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3107812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2564XOtherMEDICARE PTAN
FL3107812OtherFLORIDA NURSE PRACTITIONER LICENSE
PASP009157OtherPENNSYLVANIA NURSE PRACTITIONER LICENSE
0362956-22OtherFAMILY PRACTICE CERTIFICATION
FL002171800Medicaid
12113037OtherCAQH
FL3107812OtherFLORIDA NURSE PRACTITIONER LICENSE