MEDICARE: GUILLERMO OJEDA NURSE PRACTITIONER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11031528	FL

General Provider Information

NPI Number	:	1104682350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO OJEDA NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	12040 SW 185TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-3225
Country	:	US
Telephone Number	:	786-539-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 COLONIAL BLVD STE 226
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1026
Country	:	US
Telephone Number	:	329-502-4331
Fax Number	:	239-893-1070

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	01/25/2026

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