Provider Demographics
NPI:1144401837
Name:MARTINEZ-GUZMAN, JUAN ANDRE (PA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANDRE
Last Name:MARTINEZ-GUZMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N ROCKY POINT DR E
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5810
Mailing Address - Country:US
Mailing Address - Phone:813-289-9613
Mailing Address - Fax:
Practice Address - Street 1:3001 N ROCKY POINT DR E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5810
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100915363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical