Healthcare Provider Details

I. General information

NPI: 1124934880
Provider Name (Legal Business Name): JILLIAN PORTER MT-BC, NICU-MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 BRAFFORTON DR
TALLAHASSEE FL
32311-0709
US

IV. Provider business mailing address

1136 BRAFFORTON DR
TALLAHASSEE FL
32311-0709
US

V. Phone/Fax

Practice location:
  • Phone: 954-909-9600
  • Fax:
Mailing address:
  • Phone: 954-909-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: