Individual
JOSE JUAN CHAVAC RODAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1401
(321) 434-1667
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1401
(321) 434-1667
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APR11023149
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116517200
—
FL
01
—
QA194
MEDICARE HFPSI
FL
01
—
QA196
MEDICARE HFMG
FL
Enumeration date
11/21/2022
Last updated
02/21/2023
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