Provider Demographics
NPI:1437148814
Name:PRAFKE, JILL MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:PRAFKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 AIRPORT BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8926
Mailing Address - Country:US
Mailing Address - Phone:850-476-3696
Mailing Address - Fax:850-477-3573
Practice Address - Street 1:2114 AIRPORT BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8926
Practice Address - Country:US
Practice Address - Phone:850-476-3696
Practice Address - Fax:850-477-3573
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4608120OtherAETNA
FL260210500Medicaid
FLA922OtherHEALTH FIRST NETWORK
FL2000269OtherUNITED HEALTHCARE
FL59082833OtherBCBS AL
FL6679791004OtherCIGNA
FL51738OtherBCBSFL
FLP00105335OtherMEDICARE RR
FL6679791004OtherCIGNA
FL2000269OtherUNITED HEALTHCARE