Provider Demographics
NPI:1194736181
Name:GUZMAN, SARA INES (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:INES
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HODGES BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2345
Mailing Address - Country:US
Mailing Address - Phone:904-347-2773
Mailing Address - Fax:904-647-2647
Practice Address - Street 1:4500 HODGES BLVD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2345
Practice Address - Country:US
Practice Address - Phone:904-347-2773
Practice Address - Fax:904-647-2647
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10053753OtherAMERIGROUP CMO
GA336212OtherWELLCARE
GA092162803DMedicaid
GA52887600OtherBLUE CROSS BLUE SHIELD GA
FL006791900Medicaid
GA092162803BMedicaid
GA092162803CMedicaid
GA092162803DMedicaid
GAI30259Medicare UPIN
GA092162803DMedicaid