Individual provider Active NPI

Jessica Wong Canaval, A.R.N.P

  • Family Nurse Practitioner
  • Miami, FL
National Provider Identifier
1063953073
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN9289236 Issued in FL
Practice address
1350 NW 14TH St
Miami, FL 33125-1609
Phone
(305) 575-3800
Fax
(305) 470-5846
NPI assigned
Mar 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN9289236 FL Primary

Addresses

Primary practice location

1350 NW 14TH St
Miami, FL 33125-1609

Mailing address

8175 NW 12TH St Ste 306
Doral, FL 33126-1828
Phone (305) 575-3800

Other practice location 1

8175 NW 12th St Ste 306
Doral, FL 33126-1828
Phone (305) 575-3800

Other practice location 2

9045 SW 87th Ct
Miami, FL 33176-2304
Phone (305) 598-7715

Other identifiers 1

IdentifierTypeStateIssuer
1063953073MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jessica.wongcanaval@phpllc.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170502002454 FL Practitioner - Nurse Practitioner 0648557561 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Department of Health CurrentSince Apr 5, 2023 Accepting new patients
Florida Department of Health CurrentSince Apr 5, 2023 Accepting new patients
Florida Department of Health PastSince Oct 29, 2023 Accepting new patients
Value Healthcare Partners PastSince Dec 1, 2024 Accepting new patients

Locations

8175 NW 12th St
Ste 306
Doral, FL 33126
Phone (786) 845-0173

1350 NW 14th St
Miami, FL 33125
Phone (305) 575-3800

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1063953073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 NW 12TH ST STE 306",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331261828",
            "telephone_number": "305-575-3800",
            "fax_number": "305-470-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 NW 14TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331251609",
            "telephone_number": "305-575-3800",
            "fax_number": "305-470-5846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8175 NW 12th St Ste 306",
            "address_purpose": "LOCATION",
            "city": "Doral",
            "state": "FL",
            "postal_code": "331261828",
            "country_code": "US",
            "telephone_number": "305-575-3800",
            "fax_number": "305-470-5846",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9045 SW 87th Ct",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331762304",
            "country_code": "US",
            "telephone_number": "305-598-7715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG CANAVAL",
        "first_name": "JESSICA",
        "credential": "A.R.N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-10",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9289236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063953073",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.wongcanaval@phpllc.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "9045 SW 87th Ct",
            "city": "Miami",
            "state": "FL",
            "country_code": "US",
            "postal_code": "331762304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.