Healthcare Provider Details

I. General information

NPI: 1164584140
Provider Name (Legal Business Name): GUYLAINE LEGAULT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 SAXON BLVD
ORANGE CITY FL
32763-8214
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-0491
  • Fax: 386-774-0492
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 2715772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: