Healthcare Provider Details

I. General information

NPI: 1730857079
Provider Name (Legal Business Name): KARA GUCWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LOUISIANA AVE STE A
SAINT CLOUD FL
34769-4116
US

IV. Provider business mailing address

10907 MOSS PARK RD UNIT 1039
ORLANDO FL
32832-6065
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0122
  • Fax:
Mailing address:
  • Phone: 407-963-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: