Healthcare Provider Details

I. General information

NPI: 1275319063
Provider Name (Legal Business Name): JULIUS GREGORY GUERRA MSN, APRN, ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

11213 GENOA AVE
LUBBOCK TX
79424-3956
US

V. Phone/Fax

Practice location:
  • Phone: 830-775-8575
  • Fax:
Mailing address:
  • Phone: 830-741-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1129518
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number892148
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1129518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: