Provider Demographics
NPI:1760737894
Name:CARSON-HILL, VILMA SOPHIA (DO)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:SOPHIA
Last Name:CARSON-HILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 44004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4004
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-348-5627
Practice Address - Street 1:820 PRUDENTIAL DR STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8205
Practice Address - Country:US
Practice Address - Phone:904-374-6364
Practice Address - Fax:904-348-5627
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS12987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015600900Medicaid
FLIH185ZMedicare PIN