Healthcare Provider Details

I. General information

NPI: 1053405845
Provider Name (Legal Business Name): JILL K EADES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 S GEORGE BLVD
SEBRING FL
33875-5847
US

IV. Provider business mailing address

7205 S GEORGE BLVD
SEBRING FL
33875-5847
US

V. Phone/Fax

Practice location:
  • Phone: 863-386-6040
  • Fax: 863-386-7280
Mailing address:
  • Phone: 863-386-6040
  • Fax: 863-386-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN 2712092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: