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NPI Code Detail

MEDICARE: MRS. JILLIAN PHILLIPS

MEDICARE: MRS. JILLIAN PHILLIPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician
3103K00000XBehavior Analyst1-25-80647FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376082099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILLIAN PHILLIPS
Provider Business Mailing Address
First Line : 1615 WILMAR AVE
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34689-5776
Country : US
Telephone Number : 631-495-4224
Fax Number :
Provider Business Practice Location Address
First Line : 12823 SOLOLA WAY
Second Line :
City : TRINITY
State : FL
Zip : 34655-7246
Country : US
Telephone Number : 727-505-9949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2017
Last Update Date : 04/16/2025

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Directions to “ MRS. JILLIAN PHILLIPS ” Practice Location

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