Provider Demographics
NPI:1497051122
Name:SANBORN, JILL LOUISE (LMT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:LOUISE
Last Name:SANBORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4649 66TH PL N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5278
Mailing Address - Country:US
Mailing Address - Phone:727-430-8752
Mailing Address - Fax:
Practice Address - Street 1:4649 66TH PL N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5278
Practice Address - Country:US
Practice Address - Phone:727-430-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0012859174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist