Provider Demographics
NPI:1134425986
Name:MCGUIRE, KAMEKO HAZLEY (DNP, PMHNP-BC, NP-C)
Entity type:Individual
Prefix:DR
First Name:KAMEKO
Middle Name:HAZLEY
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, NP-C
Other - Prefix:MS
Other - First Name:KAMEKO
Other - Middle Name:D
Other - Last Name:HAZLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 E MIRACLE STRIP PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1990
Mailing Address - Country:US
Mailing Address - Phone:850-226-8096
Mailing Address - Fax:
Practice Address - Street 1:124 E MIRACLE STRIP PKWY STE 202
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1990
Practice Address - Country:US
Practice Address - Phone:850-226-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827112363LF0000X
TXAP122701363L00000X, 363LP0808X
FLARNP9246434363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331237YR09Medicare PIN