Provider Demographics
NPI:1649607136
Name:JILLEEN M. PANNOZZO, D.O., P.A.
Entity type:Organization
Organization Name:JILLEEN M. PANNOZZO, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PANNOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-733-4469
Mailing Address - Street 1:10301 HAGEN RANCH RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3724
Mailing Address - Country:US
Mailing Address - Phone:561-733-4469
Mailing Address - Fax:561-733-6858
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3724
Practice Address - Country:US
Practice Address - Phone:561-733-4469
Practice Address - Fax:561-733-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00059282084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF05802Medicare UPIN
FL80920Medicare PIN