Provider Demographics
NPI:1285866137
Name:SIRAGUSA, HILLARY P (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:P
Last Name:SIRAGUSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5101 GATE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7275
Mailing Address - Country:US
Mailing Address - Phone:904-396-1186
Mailing Address - Fax:904-396-0228
Practice Address - Street 1:5101 GATE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7275
Practice Address - Country:US
Practice Address - Phone:904-396-1186
Practice Address - Fax:904-396-0228
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2715363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical