MEDICARE: JILLIAN GINNETTI 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	PA9112826	FL
2	363AM0700X	Medical Physician Assistant	PA9112826	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811520083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN GINNETTI PA-C

Provider Business Mailing Address
First Line	:	12780 RACE TRACK RD STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1306
Country	:	US
Telephone Number	:	813-792-9541
Fax Number	:

Provider Business Practice Location Address
First Line	:	12780 RACE TRACK RD STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1306
Country	:	US
Telephone Number	:	813-792-9541
Fax Number	:	813-443-8170

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	04/06/2023

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Directions to “ JILLIAN GINNETTI PA-C” Practice Location

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