Healthcare Provider Details

I. General information

NPI: 1740962695
Provider Name (Legal Business Name): MARIANA GUEMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W DE LEON ST STE 202
TAMPA FL
33609-4130
US

IV. Provider business mailing address

2835 W DE LEON ST STE 202
TAMPA FL
33609-4130
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-2685
  • Fax: 813-876-5872
Mailing address:
  • Phone: 407-404-3100
  • Fax: 813-876-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07230918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: