MEDICARE: JILL BOTELHO M.D.

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	207VX0000X	Obstetrics Physician	ME101932	FL

General Provider Information

NPI Number	:	1982894879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL BOTELHO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 748817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8817
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	4321 N MACDILL AVE STE 205
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6390
Country	:	US
Telephone Number	:	813-961-7440
Fax Number	:	813-962-0951

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	06/23/2023

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