Provider Demographics
NPI:1013174085
Name:GUZMAN, MARISSA SOLIS (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:SOLIS
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:S
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN-C
Mailing Address - Street 1:20 BEEKMAN PL
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3102
Mailing Address - Country:US
Mailing Address - Phone:732-530-7168
Mailing Address - Fax:
Practice Address - Street 1:20 BEEKMAN PL
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3102
Practice Address - Country:US
Practice Address - Phone:732-530-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA1007099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner