Provider Demographics
NPI:1437700481
Name:GUARDIA, JISELA
Entity Type:Individual
Prefix:
First Name:JISELA
Middle Name:
Last Name:GUARDIA
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 1:905 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5005
Mailing Address - Country:US
Mailing Address - Phone:407-847-0113
Mailing Address - Fax:407-847-0183
Practice Address - Street 1:905 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5005
Practice Address - Country:US
Practice Address - Phone:407-847-0113
Practice Address - Fax:407-847-0183
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant