Provider Demographics
NPI:1669702270
Name:VERA, JOSE ANTONIO (ARNP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:VERA
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 1:4873 ROCK ROSE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9203
Mailing Address - Country:US
Mailing Address - Phone:407-688-9212
Mailing Address - Fax:407-688-9212
Practice Address - Street 1:3993 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9726
Practice Address - Country:US
Practice Address - Phone:407-732-4272
Practice Address - Fax:407-732-4579
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLARNP3163082363LA2200X
FLAPRN3163082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001702700Medicaid
FLCU472ZMedicare PIN