MEDICARE: JENNIFER DAWN BILLMAN

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	183500000X	Pharmacist	PS46496	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS46496	OTHER	FL	PHARMACIST

General Provider Information

NPI Number	:	1881298263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAWN BILLMAN

Provider Business Mailing Address
First Line	:	3904 NW 13TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-1937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 NW 13TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-1937
Country	:	US
Telephone Number	:	352-338-0554
Fax Number	:

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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