Provider Demographics
NPI:1073024840
Name:GUZMAN, KATRINA
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROADWAY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006
Mailing Address - Country:US
Mailing Address - Phone:212-796-3185
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY
Practice Address - Street 2:SUITE 504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:212-537-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9363257363L00000X
NYF342975-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner