Provider Demographics
NPI:1598482598
Name:PUPO GUERRA, JORGE INOCENCIO (APRN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:INOCENCIO
Last Name:PUPO GUERRA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 SCARBROUGH ABBY PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-3905
Mailing Address - Country:US
Mailing Address - Phone:512-783-0979
Mailing Address - Fax:
Practice Address - Street 1:1690 SCARBROUGH ABBY PL
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-3905
Practice Address - Country:US
Practice Address - Phone:512-783-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily