MEDICARE: MS. ADILEN L DILLINGHAM 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	363AS0400X	Surgical Physician Assistant	PA9101943	FL
2	363A00000X	Physician Assistant	PA9101943	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9101943	OTHER	FL	PA LICENSE

General Provider Information

NPI Number	:	1366656688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADILEN L DILLINGHAM PA-C

Provider Business Mailing Address
First Line	:	2776 FLYNN CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1801
Country	:	US
Telephone Number	:	305-458-6487
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 FLYNN CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1801
Country	:	US
Telephone Number	:	305-458-6487
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/10/2026

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