Individual
JUAN C PONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP-BC
Contact information
Practice address
8323 NW 12TH ST STE 108, DORAL, FL 33126-1839
(305) 400-8511
(305) 392-0184
Mailing address
3501 DEL PRADO BLVD S STE 303, CAPE CORAL, FL 33904-7222
(239) 317-0265
(239) 673-7681
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
APRN11012428
FL
363LF0000X
Family Nurse Practitioner
APRN11012428
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11012428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112093100
—
FL
Enumeration date
09/07/2021
Last updated
04/29/2024
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