Provider Demographics
NPI:1730695248
Name:MEREDITH, ELENA GUZMAN (FNP-C)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:GUZMAN
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10520 SE SUNSET HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-7610
Mailing Address - Country:US
Mailing Address - Phone:352-274-8430
Mailing Address - Fax:
Practice Address - Street 1:789 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3811
Practice Address - Country:US
Practice Address - Phone:386-755-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9302366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily