Provider Demographics
NPI:1447379466
Name:PARKER, JILL TORNYOS (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:TORNYOS
Last Name:PARKER
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 PASADENA AVE S
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4516
Mailing Address - Country:US
Mailing Address - Phone:727-345-2929
Mailing Address - Fax:727-345-0340
Practice Address - Street 1:1615 PASADENA AVE S
Practice Address - Street 2:SUITE 330
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4516
Practice Address - Country:US
Practice Address - Phone:727-345-2929
Practice Address - Fax:727-345-0340
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101193208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010583900Medicaid
E772OU/E772OVMedicare PIN