Individual provider Active NPI

Guerda Etienne, P.A.

  • Physician Assistant
  • Leesburg, FL
National Provider Identifier
1124171384
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9103734 Issued in FL
Practice address
312 S Lake St
Leesburg, FL 34748-5934
Phone
(352) 314-9300
Fax
(352) 314-9212
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9103734 FL Primary

Addresses

Primary practice location

312 S Lake St
Leesburg, FL 34748-5934

Mailing address

1109 SW 10TH St
Ocala, FL 34474-2725
Phone (352) 629-3455

Other practice location 1

2555 S Kirkman Rd
Orlando, FL 32811-2346
Phone (407) 362-2030

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
I20231003002920 FL Practitioner - Physician Assistant 4587018908 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carespot of Orlando Hsi Urgent Care LLCGroup PAC ID 8921372558, 55 clinicians

Practice addresses (Care Compare)

10959 W Colonial Dr Units 6 and
8 Carespot Urgent Care
Ocoee, FL 34761-2944
Phone (407) 554-4591

1615 E Hwy 50
Suite 200
Clermont, FL 34711-5124
Phone (352) 404-4463

2306 E Irlo Bronson Memorial Highwa
Kissimmee, FL 34744-5401
Phone (866) 765-2684

2306 E Irlo Bronson Memorial Hwy
Kissimmee, FL 34744-5401

2323 S Orange Ave a
Carespot Urgent Care
Orlando, FL 32806-3059
Phone (407) 418-9999

2555 S Kirkman Rd
Carespot Urgent Care
Orlando, FL 32811-2346
Phone (407) 362-2030

3840 State Rd
436 Suite 1000
Apopka, FL 32703-6041
Phone (615) 600-4074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9103734FLMDPhysician Assistant

Networks

  • Freedom Health HMO Network

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1124171384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 SW 10TH ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344742725",
            "telephone_number": "352-629-3455",
            "fax_number": "352-629-8642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 S LAKE ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485934",
            "telephone_number": "352-314-9300",
            "fax_number": "352-314-9212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2555 S Kirkman Rd",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328112346",
            "country_code": "US",
            "telephone_number": "407-362-2030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "GUERDA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.