Healthcare Provider Details

I. General information

NPI: 1811634520
Provider Name (Legal Business Name): NAISIER ANTONIE GUANIPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 WATER TOWER WAY
HYPOLUXO FL
33462-6312
US

IV. Provider business mailing address

894 WATER TOWER WAY
HYPOLUXO FL
33462-6312
US

V. Phone/Fax

Practice location:
  • Phone: 561-800-7741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: