Provider Demographics
NPI:1154909026
Name:GARCIA GUERRA, ILEANA DEL CARMEN (PA)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:DEL CARMEN
Last Name:GARCIA GUERRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNBELT STREET
Mailing Address - Street 2:APT 208
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6021
Mailing Address - Country:US
Mailing Address - Phone:585-287-2201
Mailing Address - Fax:
Practice Address - Street 1:SUNBELT STREET
Practice Address - Street 2:APT 208
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6021
Practice Address - Country:US
Practice Address - Phone:585-287-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR878-P.A.363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant