Provider Demographics
NPI:1780003459
Name:GUEVARA, JADE GIESEKE (MD)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:GIESEKE
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:ASHLEY
Other - Last Name:GIESEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1776 N PINE ISLAND RD STE 214
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5223
Mailing Address - Country:US
Mailing Address - Phone:954-452-9922
Mailing Address - Fax:954-452-7574
Practice Address - Street 1:601 N FLAMINGO RD STE 215
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-452-9922
Practice Address - Fax:352-265-1107
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME136354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025124300Medicaid