Provider Demographics
NPI:1427105626
Name:PONCE, JOSE ENRIQUE (NP)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:PONCE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2301
Mailing Address - Country:US
Mailing Address - Phone:305-819-6495
Mailing Address - Fax:
Practice Address - Street 1:1321 NW 13TH ST
Practice Address - Street 2:PRE-TRIAL DETENTION CENTER, CORRECTIONS HEALTH SERVICES
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1603
Practice Address - Country:US
Practice Address - Phone:786-263-4120
Practice Address - Fax:305-545-4042
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1375412363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04990Medicare UPIN