Basic Information
| Provider Information | |||||||||
| NPI: | 1376086934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUZMAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8569 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341018569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240437 | ||||||||
| FaxNumber: | 2396240464 | ||||||||
| Practice Location | |||||||||
| Address1: | 399 9TH ST N | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396244299 | ||||||||
| FaxNumber: | 2396438856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2016 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9110073 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | PA9110073 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | IX170Y | 01 | FL | MEDICARE | OTHER | Z3ZLO | 01 | FL | BCBS | OTHER | 019956800 | 05 | FL | MEDICAID |