Provider Demographics
NPI:1285013847
Name:GUERRERO, MARIO (ARNP)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:GUERRERO
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 1:139 N REDLAND RD STE 5
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3105
Mailing Address - Country:US
Mailing Address - Phone:786-628-8656
Mailing Address - Fax:786-650-2968
Practice Address - Street 1:139 N REDLAND RD STE 5
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3105
Practice Address - Country:US
Practice Address - Phone:786-628-8656
Practice Address - Fax:786-360-4529
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1285013847Medicaid