Provider Demographics
NPI:1881292217
Name:CASANOVA HIDALGO, JUAN ANTONIO (FNP)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:CASANOVA HIDALGO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 NW 155TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5872
Mailing Address - Country:US
Mailing Address - Phone:305-698-5300
Mailing Address - Fax:
Practice Address - Street 1:8145 NW 155TH ST STE B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5872
Practice Address - Country:US
Practice Address - Phone:305-698-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9423575163W00000X
FL11009700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse