Juan Caraballo Vazquez

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN11023166 Issued in FL

Practice address

1061 Harmon Ave
Fort Stewart, GA 31314-5641

Phone

(912) 435-6965

NPI assigned

Mar 28, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1215631015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARABALLO VAZQUEZ",
        "first_name": "JUAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PR",
            "license": "4559",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11023166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles T Canady Jr., MD
• Katrina M Canady, NCC,LPC,CPCS
• Harry Cannady
• Erin Cantrell, P.T.
• Randolph Martin Capocasale, MD
• Paul Barrington Carby, PHARM.D
• Gil Darrin Carde, LMSW
• Judy Carden, RN
• Dorothy Cardozo
• Patrick Carlson, LPN

• Family Nurse Practitioner in Fort Stewart, GA
• Providers in Fort Stewart, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.