Provider Demographics
NPI:1124564620
Name:GUILLAUME, ESDRAS (APRN)
Entity type:Individual
Prefix:MR
First Name:ESDRAS
Middle Name:
Last Name:GUILLAUME
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14331 BISCAYNE BLVD STE 610861
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33261-3000
Mailing Address - Country:US
Mailing Address - Phone:954-394-7060
Mailing Address - Fax:
Practice Address - Street 1:14311 BISCAYNE BLVD UNIT 610861
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33261-3099
Practice Address - Country:US
Practice Address - Phone:954-394-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZC0007X
FLAPRN11037095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant