Provider Demographics
NPI:1962951517
Name:GARCIA ASENCIO, JAVIER (ARNP)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:GARCIA ASENCIO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1411
Mailing Address - Country:US
Mailing Address - Phone:305-987-4675
Mailing Address - Fax:
Practice Address - Street 1:855 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4645
Practice Address - Country:US
Practice Address - Phone:305-392-1166
Practice Address - Fax:888-562-3449
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN8300583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100498800Medicaid