Healthcare Provider Details

I. General information

NPI: 1164266425
Provider Name (Legal Business Name): ALJAHRA M GUILLAUME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PARK PLACE BLVD
DAVENPORT FL
33837-6858
US

IV. Provider business mailing address

1132 ORANGE ARBOUR TRL APT 611
OCOEE FL
34761-5319
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-2812
  • Fax:
Mailing address:
  • Phone: 407-803-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9484732
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11048474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: