Provider Demographics
NPI:1235430703
Name:HILLAN, JENNIFER (MSH, RD, LD/N)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HILLAN
Suffix:
Gender:F
Credentials:MSH, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF FLORIDA PEDIATRIC PULMONARY
Mailing Address - Street 2:1600 SW ARCHER ROAD, STE D2-15
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-273-8381
Mailing Address - Fax:
Practice Address - Street 1:2000 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1136
Practice Address - Country:US
Practice Address - Phone:352-273-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3624133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEO812ZMedicare PIN