Healthcare Provider Details

I. General information

NPI: 1043026008
Provider Name (Legal Business Name): JOSE GABRIEL CHAVEZ PMHNP-BC, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 NW 29TH PL
SUNRISE FL
33323-1638
US

IV. Provider business mailing address

11401 NW 29TH PL
SUNRISE FL
33323-1638
US

V. Phone/Fax

Practice location:
  • Phone: 305-799-6552
  • Fax:
Mailing address:
  • Phone: 305-799-6552
  • Fax: 218-656-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11036668
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11036668
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9532123
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11036668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: