Provider Demographics
NPI:1720515794
Name:GUFFIN, ERIC M (ACNP-AG)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:GUFFIN
Suffix:
Gender:M
Credentials:ACNP-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PRESIDIO DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-9428
Mailing Address - Country:US
Mailing Address - Phone:210-244-3699
Mailing Address - Fax:
Practice Address - Street 1:207 PRESIDIO DR
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-9428
Practice Address - Country:US
Practice Address - Phone:210-244-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133999363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care