Provider Demographics
NPI:1477209666
Name:GUERRA, MARY ANTOINETTE EVANGELISTA (RN-BSN, SRNA)
Entity Type:Individual
Prefix:
First Name:MARY ANTOINETTE
Middle Name:EVANGELISTA
Last Name:GUERRA
Suffix:
Gender:F
Credentials:RN-BSN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 BELLEWATER PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5024
Mailing Address - Country:US
Mailing Address - Phone:407-497-0435
Mailing Address - Fax:
Practice Address - Street 1:1415 SLIGH BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3954
Practice Address - Country:US
Practice Address - Phone:407-497-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9485827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse