Provider Demographics
NPI:1720135593
Name:GUZMAN, JILL (APN NURSE PRACTITION)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:APN NURSE PRACTITION
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:206 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN111636363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics