MEDICARE: MRS. SHIRLEY DIANNE GUILLORY ARNP

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	ARNP1182132	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U6063Z	OTHER	FL	PROVIDER INS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992764005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY DIANNE GUILLORY ARNP

Provider Business Mailing Address
First Line	:	PO BOX 968
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-0968
Country	:	US
Telephone Number	:	850-951-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8457

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/23/2013

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