Healthcare Provider Details

I. General information

NPI: 1376697300
Provider Name (Legal Business Name): ANGELA GUZENSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W MIDWAY RD
FORT PIERCE FL
34981-4823
US

IV. Provider business mailing address

4500 W MIDWAY RD
FORT PIERCE FL
34981-4823
US

V. Phone/Fax

Practice location:
  • Phone: 772-778-7217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: