Basic Information
| Provider Information | |||||||||
| NPI: | 1578296901 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELASQUEZ | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | CARLOS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7623 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341017623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057127229 | ||||||||
| FaxNumber: | 3053971139 | ||||||||
| Practice Location | |||||||||
| Address1: | 11750 SW 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052233000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2022 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | APRN11020559 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | 363L00000X | APRN11020559 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.