Basic Information
| Provider Information | |||||||||
| NPI: | 1669995379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDENAS ALVAREZ | ||||||||
| FirstName: | JESUS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 VANDERBILT BCH RD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341088708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396248220 | ||||||||
| FaxNumber: | 2396248221 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 VANDERBILT BCH RD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341088708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396248220 | ||||||||
| FaxNumber: | 2396248221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9332570 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | CIVAN | 01 | FL | BCBS | OTHER | 023222300 | 05 | FL | MEDICAID | JE995Z | 01 | FL | MEDICARE | OTHER |