Healthcare Provider Details

I. General information

NPI: 1053230037
Provider Name (Legal Business Name): JUAN JOSUE GUERRA VILLANUEVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 BLARNEY ST
MINNEOLA FL
34715-7634
US

IV. Provider business mailing address

1154 BLARNEY ST
MINNEOLA FL
34715-7634
US

V. Phone/Fax

Practice location:
  • Phone: 352-630-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9416901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: