Healthcare Provider Details

I. General information

NPI: 1538958822
Provider Name (Legal Business Name): OCTAVIA GUICE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 KINGSLEY AVE STE 136-137
ORANGE PARK FL
32073-4586
US

IV. Provider business mailing address

1542 KINGSLEY AVE STE 136-137
ORANGE PARK FL
32073-4586
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 239-690-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11044066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: