Provider Demographics
NPI:1548839228
Name:DE GUZMAN, LIEZEL MEING (NP-C)
Entity type:Individual
Prefix:MISS
First Name:LIEZEL
Middle Name:MEING
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD STE 309
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1010
Mailing Address - Country:US
Mailing Address - Phone:954-450-2977
Mailing Address - Fax:
Practice Address - Street 1:601 N FLAMINGO RD STE 309
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1010
Practice Address - Country:US
Practice Address - Phone:954-450-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily