Provider Demographics
NPI: | 1376086934 |
---|---|
Name: | GUZMAN, MELISSA M (PA) |
Entity Type: | Individual |
Prefix: | |
First Name: | MELISSA |
Middle Name: | M |
Last Name: | GUZMAN |
Suffix: | |
Gender: | F |
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: | PO BOX 8569 |
Mailing Address - Street 2: | |
Mailing Address - City: | NAPLES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34101-8569 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-624-0437 |
Mailing Address - Fax: | 239-624-0464 |
Practice Address - Street 1: | 399 9TH ST N |
Practice Address - Street 2: | |
Practice Address - City: | NAPLES |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34102-5820 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-624-4299 |
Practice Address - Fax: | 239-643-8856 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-11-29 |
Last Update Date: | 2022-02-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PA9110073 | 363A00000X, 363AS0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | |
No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | IX170Y | Other | MEDICARE |
FL | Z3ZLO | Other | BCBS |
FL | 019956800 | Medicaid |