Provider Demographics
NPI:1558515643
Name:HILLARD, JACQUELINE ANTOINETTE (LMT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANTOINETTE
Last Name:HILLARD
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 1:38 WEDGE LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4000
Mailing Address - Country:US
Mailing Address - Phone:386-585-9218
Mailing Address - Fax:
Practice Address - Street 1:38 WEDGE LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-4000
Practice Address - Country:US
Practice Address - Phone:386-569-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist