Healthcare Provider Details

I. General information

NPI: 1417511957
Provider Name (Legal Business Name): VANICA MONAE GUIGNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIRCLE
ORLANDO FL
32891-1514
US

IV. Provider business mailing address

6800 GEORGIA AVE NW APT 349
WASHINGTON DC
20012-2676
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8038
  • Fax: 813-974-0483
Mailing address:
  • Phone: 305-905-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0094002
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberME162980
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberMD210001975
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: