Provider Demographics
NPI:1629531504
Name:GILLARD, JASON (HAS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GILLARD
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 SUN CITY CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6805
Mailing Address - Country:US
Mailing Address - Phone:813-634-5055
Mailing Address - Fax:
Practice Address - Street 1:3812 SUN CITY CENTER BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6805
Practice Address - Country:US
Practice Address - Phone:813-634-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3843237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist