Provider Demographics
NPI:1407096670
Name:STRUBLE, JILL S (RD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4161 CARMICHAEL AVE., BUILDING 3300
Mailing Address - Street 2:VA: HCHV SUITE 150
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-396-8750
Mailing Address - Fax:
Practice Address - Street 1:1601 ARCHER ROAD
Practice Address - Street 2:NORTH FLORIDA / SOUTH GEORGIA MALCOM RANDALL VAMC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:904-396-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003513133V00000X
FLND 5961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered