1710121678 NPI number — MRS. SANTA EMILIA GUERRA PA-C

Table of content: MRS. SANTA EMILIA GUERRA PA-C (NPI 1710121678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710121678 NPI number — MRS. SANTA EMILIA GUERRA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRA
Provider First Name:
SANTA
Provider Middle Name:
EMILIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE OLIVERIA
Provider Other First Name:
SANTA
Provider Other Middle Name:
EMILIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710121678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34277-2487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-202-5342
Provider Business Mailing Address Fax Number:
855-253-4836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7915 US HIGHWAY 301 N STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34222-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-847-1101
Provider Business Practice Location Address Fax Number:
941-417-2811
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9104920 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002034200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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