Provider Demographics
NPI:1871903393
Name:GUZZARDO, JILLIAN M (CRNA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:M
Last Name:GUZZARDO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:M
Other - Last Name:KLUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 GLEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4272
Mailing Address - Country:US
Mailing Address - Phone:917-608-5485
Mailing Address - Fax:
Practice Address - Street 1:6 GLEN COVE DR
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4272
Practice Address - Country:US
Practice Address - Phone:207-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN597580367500000X
MERNA203080367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered