Provider Demographics
NPI:1417445248
Name:GUAMBO, JESSICA MARIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:GUAMBO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9927 FLYNT CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6565
Mailing Address - Country:US
Mailing Address - Phone:407-325-7112
Mailing Address - Fax:
Practice Address - Street 1:9927 FLYNT CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6565
Practice Address - Country:US
Practice Address - Phone:407-325-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9270927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily