Healthcare Provider Details

I. General information

NPI: 1083235683
Provider Name (Legal Business Name): JUAN DAVID VARGAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1024
US

IV. Provider business mailing address

9036 SW 170TH PL
MIAMI FL
33196-2942
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone: 305-853-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11006942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: