MEDICARE: GENESIS EDLIN GUERRERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11003026	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104488907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENESIS EDLIN GUERRERO

Provider Business Mailing Address
First Line	:	2002 SUANEE AVE
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-3228
Country	:	US
Telephone Number	:	352-455-5897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1858 MAYO DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-4320
Country	:	US
Telephone Number	:	352-383-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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