Healthcare Provider Details

I. General information

NPI: 1528782471
Provider Name (Legal Business Name): GUISELLE PONCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7791 NW 146TH ST
MIAMI LAKES FL
33016-1567
US

IV. Provider business mailing address

3391 W 94TH TER
HIALEAH FL
33018-2078
US

V. Phone/Fax

Practice location:
  • Phone: 786-808-8555
  • Fax: 305-967-8497
Mailing address:
  • Phone: 305-904-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11023097
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9409364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: