Healthcare Provider Details

I. General information

NPI: 1760819627
Provider Name (Legal Business Name): GUILLOT ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 SW STONEGATE TER SUITE 109
LAKE CITY FL
32024-3458
US

IV. Provider business mailing address

4130 NW 37TH PL SUITE C
GAINESVILLE FL
32606-8152
US

V. Phone/Fax

Practice location:
  • Phone: 386-984-5578
  • Fax: 352-493-4840
Mailing address:
  • Phone: 352-377-4111
  • Fax: 352-367-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberAS4659
License Number StateFL

VIII. Authorized Official

Name: MR. TOM GUILLOT
Title or Position: PRESIDENT/OWNER
Credential: BC-HIS
Phone: 352-377-4111