Healthcare Provider Details

I. General information

NPI: 1790695856
Provider Name (Legal Business Name): PETER JUSTIN GWIAZDA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE OSCEOLA ST
STUART FL
34994-2301
US

IV. Provider business mailing address

493 SW FUGE RD
STUART FL
34997-6268
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5922
  • Fax:
Mailing address:
  • Phone: 772-285-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN9338421
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: