Healthcare Provider Details

I. General information

NPI: 1982908307
Provider Name (Legal Business Name): JILL RESLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL DAHLMAN PA

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W UNDERWOOD ST SUITE 200
ORLANDO FL
32806-1122
US

IV. Provider business mailing address

77 W UNDERWOOD ST SUITE 200
ORLANDO FL
32806-1122
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6884
  • Fax: 407-245-7059
Mailing address:
  • Phone: 407-649-6884
  • Fax: 407-245-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: