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NPI Code Detail

MEDICARE: JILL HOLLY ERBELLA PA

MEDICARE: JILL HOLLY ERBELLA PA
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
1363A00000XPhysician AssistantPA9105325FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2Y02AXOTHERFLBCBS
3PA9105325OTHERFLLICENSE NUMBER

General Provider Information

NPI Number : 1881924397
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL HOLLY ERBELLA PA
Provider Business Mailing Address
First Line : 714 MANATEE AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1235
Country : US
Telephone Number : 941-212-2010
Fax Number :
Provider Business Practice Location Address
First Line : 714 MANATEE AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1235
Country : US
Telephone Number : 941-212-2010
Fax Number : 941-212-3330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2010
Last Update Date : 03/26/2024

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Directions to “ JILL HOLLY ERBELLA PA” Practice Location

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