NPIMap

Individual provider Active NPI

Canaan Maffeo, APRN

  • Family Nurse Practitioner
  • Rockledge, FL
National Provider Identifier
1215520937
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11010122 Issued in FL
Practice address
1921 Bridgeport Cir
Rockledge, FL 32955-4335
Phone
(321) 480-5525
NPI assigned
Feb 12, 2021
Last updated
Feb 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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 11010122 FL Primary

Addresses

Primary practice location

1921 Bridgeport Cir
Rockledge, FL 32955-4335

Mailing address

1921 Bridgeport Cir
Rockledge, FL 32955-4335
Phone (321) 480-5525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210308001455 FL Practitioner - Nurse Practitioner 8921414483 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Doctors at Home Tri CountyGroup PAC ID 2567773849, 14 clinicians

Practice addresses (Care Compare)

11954 Narcoossee Rd
Orando, FL 32832-6998
Phone (800) 925-1840

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11010122FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors at Home Tri County CurrentSince Feb 15, 2021 Accepting new patients

Locations

11954 Narcoossee Rd
Ste 2
Orlando, FL 32832
Phone (407) 335-3549

11954 Narcoossee Rd
Ste 2504
Orlando, FL 32832
Phone (800) 925-1840

1417 Hamlin Ave
Unit F
Saint Cloud, FL 34771
Phone (800) 925-1840

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1215520937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 BRIDGEPORT CIR",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554335",
            "telephone_number": "321-480-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 BRIDGEPORT CIR",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554335",
            "telephone_number": "321-480-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAFFEO",
        "first_name": "CANAAN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11010122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

Verify at the official NPI Registry.