Healthcare Provider Details

I. General information

NPI: 1023540507
Provider Name (Legal Business Name): FLORENDA DE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N TOM GREEN
ODESSA TX
79761
US

IV. Provider business mailing address

1619 E EVERGLADE AVE
ODESSA TX
79762-7916
US

V. Phone/Fax

Practice location:
  • Phone: 432-580-9876
  • Fax: 432-580-9877
Mailing address:
  • Phone: 432-580-9876
  • Fax: 432-580-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP132916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: