Provider Demographics
NPI:1184704538
Name:CARDINAL, JILL WARNECKE (AUD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:WARNECKE
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CORRIE
Other - Last Name:WARNECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-688-8877
Practice Address - Street 1:2650 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4503
Practice Address - Country:US
Practice Address - Phone:941-953-4855
Practice Address - Fax:941-951-2445
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY505231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600156400Medicaid
FLS1932YMedicare PIN