Provider Demographics
NPI:1023461746
Name:GUIDO, JOLE-LANEE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JOLE-LANEE
Middle Name:
Last Name:GUIDO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:JOLE-LANEE
Other - Middle Name:
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2152
Mailing Address - Country:US
Mailing Address - Phone:480-507-5678
Mailing Address - Fax:480-507-5677
Practice Address - Street 1:2680 S VAL VISTA DR
Practice Address - Street 2:SUITE 116
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2152
Practice Address - Country:US
Practice Address - Phone:480-507-5678
Practice Address - Fax:480-507-5677
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8838363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167649Medicaid