MEDICARE: VERONICA GUAJARDO AGNP-BC

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	1058104	TX
2	363LG0600X	Gerontology Nurse Practitioner	1058104	TX

General Provider Information

NPI Number	:	1780349761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA GUAJARDO AGNP-BC

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	407-533-6836
Fax Number	:	407-232-9316

Provider Business Practice Location Address
First Line	:	122 SAINT CLOUD RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-5009
Country	:	US
Telephone Number	:	512-803-5553
Fax Number	:

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

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	07/23/2024

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