Healthcare Provider Details

I. General information

NPI: 1922496108
Provider Name (Legal Business Name): JILLIAN MARIE DOHNALEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

6062 SW 75TH TER APT 206
GAINESVILLE FL
32608-5291
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0076
  • Fax:
Mailing address:
  • Phone: 412-779-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number9113235
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTL2247
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: