Healthcare Provider Details

I. General information

NPI: 1124564620
Provider Name (Legal Business Name): ESDRAS GUILLAUME APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/16/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14311 BISCAYNE BLVD UNIT 610861
NORTH MIAMI FL
33261-3099
US

IV. Provider business mailing address

14331 BISCAYNE BLVD STE 610861
NORTH MIAMI FL
33261-3000
US

V. Phone/Fax

Practice location:
  • Phone: 954-394-7060
  • Fax:
Mailing address:
  • Phone: 954-394-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11037095
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: