Healthcare Provider Details

I. General information

NPI: 1275154445
Provider Name (Legal Business Name): JEAROLD JEROME HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14594 DEACON CT
SPRING HILL FL
34609-0701
US

IV. Provider business mailing address

14594 DEACON CT
SPRING HILL FL
34609-0701
US

V. Phone/Fax

Practice location:
  • Phone: 813-334-8546
  • Fax:
Mailing address:
  • Phone: 813-334-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberRN9360443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: