Healthcare Provider Details

I. General information

NPI: 1245839612
Provider Name (Legal Business Name): RANCHA EXANTUS JUNCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S FEDERAL HWY STE 3
BOYNTON BEACH FL
33435-5610
US

IV. Provider business mailing address

639 E OCEAN AVE STE 409
BOYNTON BEACH FL
33435-5017
US

V. Phone/Fax

Practice location:
  • Phone: 561-735-6553
  • Fax: 561-735-7739
Mailing address:
  • Phone: 561-735-6553
  • Fax: 561-735-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009744
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11009744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: