MEDICARE: MRS. GLORY IVELISSE GUERRERO ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP9202595	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	:	1427032028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORY IVELISSE GUERRERO ARNP

Provider Business Mailing Address
First Line	:	2272 SE LUCAYA ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6820
Country	:	US
Telephone Number	:	772-398-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1696 SE HILLMOOR DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-692-2024
Fax Number	:	772-692-1555

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	11/17/2023

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