MEDICARE: GLORIANNA ILOFF PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA07296	TX

General Provider Information

NPI Number	:	1285926063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIANNA ILOFF PA-C

Provider Business Mailing Address
First Line	:	114 SPROLES DR STE 101
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3249
Country	:	US
Telephone Number	:	817-249-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 SPROLES DR STE 101
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3249
Country	:	US
Telephone Number	:	817-249-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	08/06/2024

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