Individual provider Active NPI

Janella San Juan

  • Psychiatric/Mental Health Nurse Practitioner
  • Longwood, FL
National Provider Identifier
1639577422
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN11004193 Issued in FL
Practice address
1155 W Sr 434 # 150
Longwood, FL 32750-4987
Phone
(407) 917-3253
Fax
(855) 350-5708
NPI assigned
Dec 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5022105 NC
Psychiatric/Mental Health Registered Nurse 163WP0808X RN9386595 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95020218 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN11004193 FL Primary
Family Nurse Practitioner 363LF0000X APRN11004193 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209.034205 IL

Addresses

Primary practice location

1155 W Sr 434 # 150
Longwood, FL 32750-4987

Mailing address

1155 W State Road 434 Ste 115
Longwood, FL 32750-4965

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
I20230109000724 FL Practitioner - Nurse Practitioner 1456721414 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Brightside Health IncGroup PAC ID 9234525098, 213 clinicians
Brave Health Inc.Group PAC ID 8123458981, 112 clinicians

Practice addresses (Care Compare)

Jacksonville, FL 32211
Phone (415) 360-3348

1071 Hawthorne Cove Dr
Ocoee, FL 34761-2455
Phone (305) 902-6347

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN9386595FLMDPsychiatric/Mental Health Registered Nurse
95020218CAMDPsychiatric/Mental Health Nurse Practitioner
APRN11004193FLMDPsychiatric/Mental Health Nurse Practitioner
209.034205ILMDPsychiatric/Mental Health Nurse Practitioner
5022105NCMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brightside Health, Inc. CurrentSince Feb 1, 2026 Accepting new patients
Brave Health Inc. CurrentSince Apr 2, 2025 Accepting new patients

Locations

2261 Market St
San Francisco, CA 94114
Phone (213) 337-4615

6501 Arlington Expy
Ste B105
Jacksonville, FL 32211
Phone (904) 302-9355

Organizations & group practices 2

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": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1639577422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 W STATE ROAD 434 STE 115",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327504965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 W SR 434 # 150",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327504987",
            "telephone_number": "407-917-3253",
            "fax_number": "855-350-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN JUAN",
        "first_name": "JANELLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-11",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5022105",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "FL",
            "license": "RN9386595",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95020218",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11004193",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11004193",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.034205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longwood, FL

Sources for this page

Verify at the official NPI Registry.