Provider Demographics
NPI:1700363397
Name:TRONCOSO, JOSE CARLOS SR (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:CARLOS
Last Name:TRONCOSO
Suffix:SR
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 1:4670 W 13TH LN APT 406
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3242
Mailing Address - Country:US
Mailing Address - Phone:786-458-2822
Mailing Address - Fax:
Practice Address - Street 1:4670 W 13TH LN APT 406
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3242
Practice Address - Country:US
Practice Address - Phone:786-458-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07181655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily