Provider Demographics
NPI:1154919603
Name:ACOSTA GUZMAN, JUAN (APRN)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:ACOSTA GUZMAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 W 16TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7190
Mailing Address - Country:US
Mailing Address - Phone:786-778-7449
Mailing Address - Fax:786-685-3908
Practice Address - Street 1:4445 W 16TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7190
Practice Address - Country:US
Practice Address - Phone:786-234-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner