MEDICARE: PROVIESS JILES

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	376J00000X	Homemaker		FL
2	376K00000X	Nurse's Aide	376K00000X	FL
3	172A00000X	Driver	172A0000X	FL
4	372500000X	Chore Provider		FL
5	372600000X	Adult Companion		FL
6	374U00000X	Home Health Aide		FL

General Provider Information

NPI Number	:	1750820932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROVIESS JILES

Provider Business Mailing Address
First Line	:	2343 LAKE WESTON DR
Second Line	:	1516
City	:	ORLANDO
State	:	FL
Zip	:	32810-4492
Country	:	US
Telephone Number	:	401-327-1354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 LAKE WESTON DR
Second Line	:	1516
City	:	ORLANDO
State	:	FL
Zip	:	32810-4492
Country	:	US
Telephone Number	:	401-327-1354
Fax Number	:

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

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	02/21/2017

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Directions to “ PROVIESS JILES ” Practice Location

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