Healthcare Provider Details

I. General information

NPI: 1487541652
Provider Name (Legal Business Name): JULIO JUAN LUIS ESTEBAN IV IV APRN , CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

16824 MOSS TREE LOOP APT 317
LAND O LAKES FL
34638-0078
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-7451
  • Fax:
Mailing address:
  • Phone: 904-814-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11040115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: