Provider Demographics
NPI:1467056176
Name:GUEVARA, ILSE JOHANNA (FNP)
Entity Type:Individual
Prefix:
First Name:ILSE
Middle Name:JOHANNA
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1350
Mailing Address - Country:US
Mailing Address - Phone:786-312-9875
Mailing Address - Fax:
Practice Address - Street 1:664 BIRD RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1350
Practice Address - Country:US
Practice Address - Phone:786-312-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9421801163W00000X
FLAPRN11010659363LF0000X
FLF11200763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse