Provider Demographics
NPI:1548803836
Name:GUADARRAMA, ELIZABETH (APRNCB)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GUADARRAMA
Suffix:
Gender:F
Credentials:APRNCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 W 16TH AVE STE 130U
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4683
Mailing Address - Country:US
Mailing Address - Phone:786-431-1036
Mailing Address - Fax:
Practice Address - Street 1:3750 W 16TH AVE STE 130U
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4683
Practice Address - Country:US
Practice Address - Phone:786-431-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10190408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty