Provider Demographics
NPI:1245864164
Name:CANCIO, JOSE ANDRO (MSN-APRN-PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANDRO
Last Name:CANCIO
Suffix:
Gender:M
Credentials:MSN-APRN-PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20733 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3514
Mailing Address - Country:US
Mailing Address - Phone:305-204-1209
Mailing Address - Fax:305-402-0959
Practice Address - Street 1:12550 BISCAYNE BLVD STE 507
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2544
Practice Address - Country:US
Practice Address - Phone:305-204-1209
Practice Address - Fax:305-402-0959
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLAPRN11006259363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily