Healthcare Provider Details

I. General information

NPI: 1548425937
Provider Name (Legal Business Name): CILIO NELSON GUERRIERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 N DALE MABRY HWY SUITE 200
TAMPA FL
33618-2075
US

IV. Provider business mailing address

14502 N DALE MABRY HWY SUITE 200
TAMPA FL
33618-2075
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-4484
  • Fax: 813-265-1522
Mailing address:
  • Phone: 813-960-4484
  • Fax: 813-265-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME14463
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME14463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: