Provider Demographics
NPI:1427032028
Name:GUERRERO, GLORY IVELISSE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GLORY
Middle Name:IVELISSE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 SE LUCAYA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6820
Mailing Address - Country:US
Mailing Address - Phone:772-398-4757
Mailing Address - Fax:
Practice Address - Street 1:1696 SE HILLMOOR DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-692-2024
Practice Address - Fax:772-692-1555
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307100600Medicaid