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General NPI Number Information
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NPI Number | 1932882370
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Entity Type | Individual
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Provider Name | JILLIAN SUEZANNE KIRK
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 601 E ROLLINS ST STE 125
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City | ORLANDO
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State | FL
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Zip | 32803-1248
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Country | US
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Telephone | 407-646-7165
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N ORANGE AVE APT 166
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City | ORLANDO
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State | FL
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Zip | 32801-1177
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Country | US
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Telephone | 732-492-2589
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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 | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number | TGC683
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License Number State | FL
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