Healthcare Provider Details

I. General information

NPI: 1235025768
Provider Name (Legal Business Name): MARK CHRISTIAN ROSALES GUCE RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OCOEE APOPKA RD
APOPKA FL
32703-9210
US

IV. Provider business mailing address

678 AUTUMN OAKS LOOP
MOUNT DORA FL
32757-3000
US

V. Phone/Fax

Practice location:
  • Phone: 407-609-7217
  • Fax:
Mailing address:
  • Phone: 407-430-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9584369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: