MEDICARE: JOHN JOSEPH DE GUZMAN APRN

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	363LF0000X	Family Nurse Practitioner	APRN811917	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306626759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH DE GUZMAN APRN

Provider Business Mailing Address
First Line	:	9033 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5745
Country	:	US
Telephone Number	:	702-476-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 W HORIZON RIDGE PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-3494
Country	:	US
Telephone Number	:	702-476-9999
Fax Number	:

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

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	04/22/2026

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