Provider Demographics
NPI:1497193247
Name:GUTH, ELLEN MCANDREWS (ARNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MCANDREWS
Last Name:GUTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:KATHERINE
Other - Last Name:MCANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJAX - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:841 PRUDENTIAL DR
Practice Address - Street 2:UFJAX - PEDS MULTISPECIALTY CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8329
Practice Address - Country:US
Practice Address - Phone:904-633-0780
Practice Address - Fax:904-633-0781
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9297852363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135827AMedicaid
FL009122100Medicaid
FLHK733ZMedicare PIN