Healthcare Provider Details

I. General information

NPI: 1790150233
Provider Name (Legal Business Name): GUILLOT ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N COLLIER BLVD SUITE 402
MARCO ISLAND FL
34145-2725
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 239-642-3805
  • Fax: 239-394-2830
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 NumberAS3293
License Number StateFL

VIII. Authorized Official

Name: THOMAS W GUILLOT
Title or Position: OWNER/PRESIDENT
Credential: BC HIS
Phone: 352-377-4111