Healthcare Provider Details

I. General information

NPI: 1962772269
Provider Name (Legal Business Name): GLORIA MICHELLE GUESS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WHITEHALL DR
ST AUGUSTINE FL
32086-5266
US

IV. Provider business mailing address

7015 A C SKINNER PKWY STE 1
JACKSONVILLE FL
32256-6932
US

V. Phone/Fax

Practice location:
  • Phone: 907-825-4500
  • Fax: 904-825-3672
Mailing address:
  • Phone: 904-363-2113
  • Fax: 904-363-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberAPRN9194629
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN9194629
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License NumberAPRN9194629
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9194629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: