Individual
DR. TAMARA IVELISSE GUZMAN RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
130 RIDGE CENTER DR, DAVENPORT, FL 33837-6413
(866) 234-8534
Mailing address
47 5TH ST NW, WINTER HAVEN, FL 33881-4672
(866) 234-8534
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
15632
PR
208D00000X
General Practice Physician
Primary
ACN 448
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063443612
—
FL
01
—
ACN 448
LICENSE
FL
Enumeration date
07/05/2006
Last updated
03/07/2023
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