Provider Demographics
NPI:1295278521
Name:HILLER, ILANA (ARNP)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:HILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 KINGSLEY AVE STE 118119
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4587
Mailing Address - Country:US
Mailing Address - Phone:904-298-2113
Mailing Address - Fax:
Practice Address - Street 1:1536 KINGSLEY AVE STE 118
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4525
Practice Address - Country:US
Practice Address - Phone:904-272-3307
Practice Address - Fax:904-298-1922
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9213987363LF0000X
FL9213987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily