Provider Demographics
NPI:1750771341
Name:DR. JILL, INC.
Entity type:Organization
Organization Name:DR. JILL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:HINEGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:813-220-8192
Mailing Address - Street 1:708 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2429
Mailing Address - Country:US
Mailing Address - Phone:813-419-1745
Mailing Address - Fax:813-922-6607
Practice Address - Street 1:708 KINGSTON CT
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2429
Practice Address - Country:US
Practice Address - Phone:813-419-1745
Practice Address - Fax:813-922-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9718251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health