Provider Demographics
NPI:1740899129
Name:GUERRA TEJERA, MARLON FAUSTINO (APRN)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:FAUSTINO
Last Name:GUERRA TEJERA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13258 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7130
Mailing Address - Country:US
Mailing Address - Phone:786-394-3481
Mailing Address - Fax:
Practice Address - Street 1:3351 EXECUTIVE WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3935
Practice Address - Country:US
Practice Address - Phone:954-628-5361
Practice Address - Fax:954-380-8379
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily