Provider Demographics
NPI:1497949499
Name:GUZMAN, JACQUELINE LIZARDO (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LIZARDO
Last Name:GUZMAN
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 1:427 SHADY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1701
Mailing Address - Country:US
Mailing Address - Phone:469-500-2458
Mailing Address - Fax:
Practice Address - Street 1:ENVISION PHYSICIAN SERVICES
Practice Address - Street 2:645 E. MISSOURI AVE. STE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-476-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8941363L00000X
AZAP8686363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner