MEDICARE: JESSICA LEANN GUERRA AP, DOM

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	171100000X	Acupuncturist	AP3313	FL

General Provider Information

NPI Number	:	1326478678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEANN GUERRA AP, DOM

Provider Business Mailing Address
First Line	:	21234 OLEAN BLVD
Second Line	:	UNIT 4
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6752
Country	:	US
Telephone Number	:	941-626-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	21234 OLEAN BLVD
Second Line	:	UNIT 4
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6752
Country	:	US
Telephone Number	:	941-626-1992
Fax Number	:

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

Provider Enumeration Date	:	11/23/2013
Last Update Date	:	11/23/2013

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