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General NPI Number Information
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NPI Number | 1154617454
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Entity Type | Individual
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Provider Name | JOSE A VERGARA ARNP
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Gender | Male
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 7375 W 18 AVE
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City | HIALEAH
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State | FL
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Zip | 33014
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Country | US
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Telephone | 305-333-8623
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Fax |
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Provider Business Mailing Address
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Address Line | 7375 W 18 AVE
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City | HIALEAH
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State | FL
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Zip | 33014
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Country | US
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Telephone | 305-333-8623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9380680
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License Number State | FL
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