Provider Demographics
NPI:1831375385
Name:GLASS, JILLIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S WESTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1744
Mailing Address - Country:US
Mailing Address - Phone:813-251-1076
Mailing Address - Fax:813-251-1476
Practice Address - Street 1:202 S WESTLAND AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1744
Practice Address - Country:US
Practice Address - Phone:813-251-1076
Practice Address - Fax:813-251-1476
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME842472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry