Provider Demographics
NPI:1730669755
Name:ALFONSO, JUAN CARLOS II (ARNP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:ALFONSO
Suffix:II
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 1:17984 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1690
Mailing Address - Country:US
Mailing Address - Phone:786-213-3301
Mailing Address - Fax:
Practice Address - Street 1:17984 SW 35TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-1690
Practice Address - Country:US
Practice Address - Phone:786-213-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9344269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily