Provider Demographics
NPI:1023470366
Name:GUAJARDO, FELICITY MELODEE (APRN-AGCNS-BC)
Entity type:Individual
Prefix:
First Name:FELICITY
Middle Name:MELODEE
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:APRN-AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11539 BUFFALO HORN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2512
Mailing Address - Country:US
Mailing Address - Phone:210-793-5189
Mailing Address - Fax:
Practice Address - Street 1:19432 DAVIS STREET
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052
Practice Address - Country:US
Practice Address - Phone:830-709-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130273364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist