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General NPI Number Information
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NPI Number | 1821814146
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Entity Type | Individual
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Provider Name | JILLIAN RAE FOERTSCH
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1 TAMPA GENERAL CIR
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City | TAMPA
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State | FL
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Zip | 33606-3571
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Country | US
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Telephone | 813-844-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 10213 COOL WATERLILY AVE
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City | RIVERVIEW
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State | FL
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Zip | 33578-4380
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Country | US
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Telephone | 631-487-5414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN9522965
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 11037463
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11037463
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License Number State | FL
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