Provider Demographics
NPI:1841935152
Name:GUAJARDO-HALATCHEV, MARCIA ANDREA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANDREA
Last Name:GUAJARDO-HALATCHEV
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1009
Mailing Address - Country:US
Mailing Address - Phone:305-562-1221
Mailing Address - Fax:
Practice Address - Street 1:8620 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1009
Practice Address - Country:US
Practice Address - Phone:305-562-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019459363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care