Provider Demographics
NPI:1063202505
Name:BARRANTES, JILKA (STUDENT INTERN)
Entity type:Individual
Prefix:
First Name:JILKA
Middle Name:
Last Name:BARRANTES
Suffix:
Gender:
Credentials:STUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20052 SW MARINE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-3521
Mailing Address - Country:US
Mailing Address - Phone:305-310-6479
Mailing Address - Fax:
Practice Address - Street 1:3404 N LECANTO HWY STE D
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3569
Practice Address - Country:US
Practice Address - Phone:352-419-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program