Provider Demographics
NPI:1457172314
Name:JIRON-HOLLMAN, JILLIAN (COA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:JIRON-HOLLMAN
Suffix:
Gender:F
Credentials:COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 HIGH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8921
Mailing Address - Country:US
Mailing Address - Phone:386-871-9776
Mailing Address - Fax:
Practice Address - Street 1:4035 HIGH RIDGE DR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8921
Practice Address - Country:US
Practice Address - Phone:386-871-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant