Provider Demographics
NPI:1528215639
Name:GILLIOM AUDIOLOGY, P.A.
Entity Type:Organization
Organization Name:GILLIOM AUDIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-399-3323
Mailing Address - Street 1:2051 ART MUSEUM DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2596
Mailing Address - Country:US
Mailing Address - Phone:904-399-3323
Mailing Address - Fax:904-399-3360
Practice Address - Street 1:2051 ART MUSEUM DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2596
Practice Address - Country:US
Practice Address - Phone:904-399-3323
Practice Address - Fax:904-399-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY741231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1412Medicare PIN