Provider Demographics
NPI:1699128736
Name:DE GUZMAN, MELANIE (ARNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 NW LAKE WHITNEY PLACE
Mailing Address - Street 2:101
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1622
Mailing Address - Country:US
Mailing Address - Phone:772-249-0260
Mailing Address - Fax:772-249-0137
Practice Address - Street 1:579 NW LAKE WHITNEY PLACE
Practice Address - Street 2:101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1622
Practice Address - Country:US
Practice Address - Phone:772-249-0260
Practice Address - Fax:772-249-0137
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9331728363LF0000X
FLARNP9331728363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily