Healthcare Provider Details

I. General information

NPI: 1881318376
Provider Name (Legal Business Name): DR. MCGUIRE, NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MIRACLE STRIP PKWY STE 202
MARY ESTHER FL
32569-1990
US

IV. Provider business mailing address

124 E MIRACLE STRIP PKWY STE 202
MARY ESTHER FL
32569-1990
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-8096
  • Fax:
Mailing address:
  • Phone: 850-226-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMEKO HAZLEY MCGUIRE
Title or Position: CEO/NP
Credential: NP
Phone: 850-226-8096