Provider Demographics
NPI:1821186339
Name:ADERA, JILL PERNIGOTTI (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:PERNIGOTTI
Last Name:ADERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2532
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-2532
Mailing Address - Country:US
Mailing Address - Phone:352-341-2800
Mailing Address - Fax:
Practice Address - Street 1:227 ELLA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-3911
Practice Address - Country:US
Practice Address - Phone:352-341-2800
Practice Address - Fax:352-341-2900
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273658600Medicaid
FL52152OtherBCBS
FL1821186339OtherNPI
FL372203OtherHE INV
FL21252405225OtherBEECH STREET
FL372203OtherHE LEC
FL373178OtherHE CR
FL5935028431021OtherTRICARE
FL5935028431021OtherTRICARE
FLBA8201410OtherDEA