Healthcare Provider Details

I. General information

NPI: 1912283763
Provider Name (Legal Business Name): JILLIAN NICOLE GERSTENBERGER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE SUITE 495
HOLLYWOOD FL
33021-5424
US

IV. Provider business mailing address

1150 N 35TH AVE SUITE 495
HOLLYWOOD FL
33021-5424
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-1717
  • Fax: 954-893-6325
Mailing address:
  • Phone: 954-265-1717
  • Fax: 954-893-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1696
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY 1696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: