Provider Demographics
NPI:1679893960
Name:DAVISON, JILLIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:A
Last Name:DAVISON
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 1:1720 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2912
Mailing Address - Country:US
Mailing Address - Phone:321-841-5236
Mailing Address - Fax:407-426-7443
Practice Address - Street 1:1720 COOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2912
Practice Address - Country:US
Practice Address - Phone:321-841-5236
Practice Address - Fax:407-426-7443
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115997207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine