Individual provider Active NPI

Elsa Milagros Agurto Guanzon

  • Nurse Practitioner
  • Brandon, FL
National Provider Identifier
1063995751
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9198265 Issued in FL
Practice address
621 W Lumsden Rd
Brandon, FL 33511-5911
Phone
(813) 755-3500
Fax
(813) 755-3300
NPI assigned
Sep 10, 2018
Last updated
Sep 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9198265 FL Primary

Addresses

Primary practice location

621 W Lumsden Rd
Brandon, FL 33511-5911

Mailing address

621 W Lumsden Rd
Brandon, FL 33511-5911
Phone (813) 755-3500

Other practice location 1

635 Eichenfeld Dr
Brandon, FL 33511
Phone (813) 684-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190710000232 FL Practitioner - Nurse Practitioner 0244565596 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89.07 of 100Reported as group
Quality
76.33
Improvement activities
40
Cost
78.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Physician Assistant

State licenses

LicenseStateTypeSpecialty
9198265FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Heart Vascular and Vein of Tampa Bay LLC CurrentSince Sep 15, 2020 Accepting new patients
Sunshine Pulmonary and Sleep Medicine P.a. CurrentSince Sep 15, 2020 Accepting new patients

Locations

621 W Lumsden Rd
Brandon, FL 33511
Phone (813) 655-1100

10141 Big Bend Rd
Ste 201
Riverview, FL 33578
Phone (813) 684-3707

1901 Haverford Ave
Ste 111
Sun City Ctr, FL 33573
Phone (813) 755-3500

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1063995751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 W LUMSDEN RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115911",
            "telephone_number": "813-755-3500",
            "fax_number": "813-755-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W LUMSDEN RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115911",
            "telephone_number": "813-755-3500",
            "fax_number": "813-755-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "635 Eichenfeld Dr",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "33511",
            "country_code": "US",
            "telephone_number": "813-684-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGURTO GUANZON",
        "first_name": "ELSA",
        "middle_name": "MILAGROS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9198265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.