Healthcare Provider Details

I. General information

NPI: 1164163788
Provider Name (Legal Business Name): CHERRY GUADEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 DOCS GROVE CIR STE 120
ORLANDO FL
32819-8010
US

IV. Provider business mailing address

7412 DOCS GROVE CIR
ORLANDO FL
32819-8010
US

V. Phone/Fax

Practice location:
  • Phone: 407-363-7760
  • Fax:
Mailing address:
  • Phone: 407-363-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9410581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: