Provider Demographics
NPI:1649210337
Name:GILLIS, JACINTA IRENE (MD)
Entity Type:Individual
Prefix:MS
First Name:JACINTA
Middle Name:IRENE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 KAUREEN GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1695
Mailing Address - Country:US
Mailing Address - Phone:813-412-6345
Mailing Address - Fax:
Practice Address - Street 1:8005 KAUREEN GARDEN PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1695
Practice Address - Country:US
Practice Address - Phone:813-412-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99298208M00000X
TN355955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine