Provider Demographics
NPI:1447379466
Name:PARKER, JILL TORNYOS (PA-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:TORNYOS
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 7TH ST S STE 205
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4748
Mailing Address - Country:US
Mailing Address - Phone:727-893-6234
Mailing Address - Fax:727-553-7798
Practice Address - Street 1:701 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4814
Practice Address - Country:US
Practice Address - Phone:727-893-6297
Practice Address - Fax:727-893-6287
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101193363AS0400X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010583900Medicaid
E772OU/E772OVMedicare PIN