Provider Demographics
NPI:1992824692
Name:GUERRA, GUILLERMO EDGARDO (APRN)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:EDGARDO
Last Name:GUERRA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 NW 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4415
Mailing Address - Country:US
Mailing Address - Phone:832-713-4765
Mailing Address - Fax:
Practice Address - Street 1:2056 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2270
Practice Address - Country:US
Practice Address - Phone:954-561-3663
Practice Address - Fax:954-566-7868
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily