Basic Information
| Provider Information | |||||||||
| NPI: | 1225599228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUZMAN RODRIGUEZ | ||||||||
| FirstName: | RAMON | ||||||||
| MiddleName: | LUIS GERARDO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 W COPELAND DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 W COPELAND DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2019 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11001919 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | APRN11001919 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 104922100 | 05 | FL | MEDICAID |