Healthcare Provider Details

I. General information

NPI: 1174387724
Provider Name (Legal Business Name): GUEDRY EDOUARD NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15407 IBIS FALL PL
SUN CITY CENTER FL
33573-6782
US

IV. Provider business mailing address

15407 IBIS FALL PL
SUN CITY CENTER FL
33573-6782
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-1157
  • Fax:
Mailing address:
  • Phone: 239-692-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11031228
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP11031228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: