MEDICARE: MR. NELSON ANTHONY GUZMAN PA-C

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	363A00000X	Physician Assistant	PA9105161	FL

General Provider Information

NPI Number	:	1922332204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NELSON ANTHONY GUZMAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-8260
Fax Number	:	239-343-8261

Provider Business Practice Location Address
First Line	:	5216 CLAYTON CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2116
Country	:	US
Telephone Number	:	239-343-8260
Fax Number	:	239-343-8261

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

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	03/25/2021

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