Healthcare Provider Details

I. General information

NPI: 1093661027
Provider Name (Legal Business Name): JONATHAN ISRAEL CUENCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11749 NW 12TH ST
PEMBROKE PINES FL
33026-4356
US

IV. Provider business mailing address

11749 NW 12TH ST
PEMBROKE PINES FL
33026-4356
US

V. Phone/Fax

Practice location:
  • Phone: 954-225-9769
  • Fax:
Mailing address:
  • Phone: 954-225-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11045954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: