Healthcare Provider Details

I. General information

NPI: 1962223032
Provider Name (Legal Business Name): ALEXANDRA GUZMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-797-4771
  • Fax: 856-797-4785
Mailing address:
  • Phone: 856-797-4771
  • Fax: 856-797-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15182200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: