Healthcare Provider Details

I. General information

NPI: 1225599228
Provider Name (Legal Business Name): RAMON LUIS GERARDO GUZMAN RODRIGUEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

IV. Provider business mailing address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7550
  • Fax: 321-841-8185
Mailing address:
  • Phone: 321-841-7550
  • Fax: 321-841-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11001919
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11001919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: