Healthcare Provider Details

I. General information

NPI: 1720135593
Provider Name (Legal Business Name): JILL GUZMAN APN NURSE PRACTITION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL SANTANA APN

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

IV. Provider business mailing address

206 ANDOVER DR
WAYNE NJ
07470-2958
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-9320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNN111636
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: