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Individual

THEA DE GUZMAN INTAL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
36 NEWARK AVE STE 300, BELLEVILLE, NJ 07109-4122
(973) 873-0195
Mailing address
36 NEWARK AVE STE 300, BELLEVILLE, NJ 07109-4122
(973) 873-0195

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ14933100
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0960691
NJ
Enumeration date
10/09/2023
Last updated
12/26/2023
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