MEDICARE: DIANA GUIA FNP

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	APRN11025178	FL

General Provider Information

NPI Number	:	1952003675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GUIA FNP

Provider Business Mailing Address
First Line	:	4209 ABERNATHY WAY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-1348
Country	:	US
Telephone Number	:	786-458-0103
Fax Number	:

Provider Business Practice Location Address
First Line	:	4209 ABERNATHY WAY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-1348
Country	:	US
Telephone Number	:	786-458-0103
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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