Healthcare Provider Details

I. General information

NPI: 1912821158
Provider Name (Legal Business Name): GUADALUPE L GUANZON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 MARSH BLUFF DR
JACKSONVILLE FL
32226-4784
US

IV. Provider business mailing address

3931 MARSH BLUFF DR
JACKSONVILLE FL
32226-4784
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-5972
  • Fax: 904-329-1477
Mailing address:
  • Phone: 904-446-5972
  • Fax: 904-329-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: