MEDICARE: JUAN CARLOS TORRES ACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician	2020039837	DC
2	363L00000X	Nurse Practitioner	0024180435	VA

General Provider Information

NPI Number	:	1811500754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS TORRES ACNP-BC

Provider Business Mailing Address
First Line	:	4100 DAVID LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1113
Country	:	US
Telephone Number	:	832-525-3237
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 DAVID LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1113
Country	:	US
Telephone Number	:	832-525-3237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	03/19/2021

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