MEDICARE: SUYEN MARINO GUTIERREZ

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	163WG0000X	General Practice Registered Nurse	11033156	FL
2	363LF0000X	Family Nurse Practitioner	11033156	FL

General Provider Information

NPI Number	:	1871331777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUYEN MARINO GUTIERREZ

Provider Business Mailing Address
First Line	:	3110 W HAYA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-6737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 W HAYA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-6737
Country	:	US
Telephone Number	:	813-263-8698
Fax Number	:

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

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	12/10/2025

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Directions to “ SUYEN MARINO GUTIERREZ ” Practice Location

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