Healthcare Provider Details

I. General information

NPI: 1649607136
Provider Name (Legal Business Name): JILLEEN M. PANNOZZO, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD SUITE 7
BOYNTON BEACH FL
33437-3724
US

IV. Provider business mailing address

10301 HAGEN RANCH RD SUITE 7
BOYNTON BEACH FL
33437-3724
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-4469
  • Fax: 561-733-6858
Mailing address:
  • Phone: 561-733-4469
  • Fax: 561-733-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberOS0005928
License Number StateFL

VIII. Authorized Official

Name: DR. JILLEEN MARIE PANNOZZO
Title or Position: PSYCHIATRIST
Credential: D.O.
Phone: 561-733-4469