Basic Information
| Provider Information | |||||||||
| NPI: | 1538292701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUAREZ | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | JULIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 W DR MARTIN LUTHER KING JR BLVD STE 850 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138712717 | ||||||||
| FaxNumber: | 8138763558 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 W DR MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138712717 | ||||||||
| FaxNumber: | 8138763558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9103699 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA9103699 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 153829701 | 05 | FL | MEDICAID |