Healthcare Provider Details

I. General information

NPI: 1457059933
Provider Name (Legal Business Name): MARIOLA GARCIA GUERRA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SW 107TH AVE
MIAMI FL
33165-7344
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 786-636-1402
  • Fax:
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11024723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: