Individual
JUAN CARABALLO VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4559
PR
363LF0000X
Family Nurse Practitioner
Primary
APRN11023166
FL
Other
Enumeration date
03/28/2023
Last updated
10/28/2024
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