Provider Demographics
NPI:1801187000
Name:CRISTINA GILLIS
Entity Type:Organization
Organization Name:CRISTINA GILLIS
Other - Org Name:AMELIA ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:904-206-9887
Mailing Address - Street 1:12220 CAP FERRAT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-6755
Mailing Address - Country:US
Mailing Address - Phone:904-206-9887
Mailing Address - Fax:
Practice Address - Street 1:961687 GATEWAY BLVD STE 201N
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-9159
Practice Address - Country:US
Practice Address - Phone:904-206-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2964171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty