Provider Demographics
NPI:1790346732
Name:MEDARD, GUIRLENE BASTIEN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GUIRLENE
Middle Name:BASTIEN
Last Name:MEDARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5664 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5677
Mailing Address - Country:US
Mailing Address - Phone:305-744-2154
Mailing Address - Fax:
Practice Address - Street 1:5664 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5677
Practice Address - Country:US
Practice Address - Phone:813-666-2714
Practice Address - Fax:352-565-4131
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9353569363LF0000X
FLAPRN9353569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116101400Medicaid