MEDICARE: GINA DEGUZMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093011538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA DEGUZMAN

Provider Business Mailing Address
First Line	:	11428 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2216
Country	:	US
Telephone Number	:	813-374-9416
Fax Number	:	813-443-5795

Provider Business Practice Location Address
First Line	:	11428 N 53RD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2216
Country	:	US
Telephone Number	:	813-374-9416
Fax Number	:	813-443-5795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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Directions to “ GINA DEGUZMAN ” Practice Location

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