Provider Demographics
NPI:1063237527
Name:HILLHOUSE, EDWARD DALE II
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:DALE
Last Name:HILLHOUSE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 NW 6TH PL STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6116
Mailing Address - Country:US
Mailing Address - Phone:352-377-5600
Mailing Address - Fax:
Practice Address - Street 1:4423 NW 6TH PL STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6116
Practice Address - Country:US
Practice Address - Phone:352-377-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033364363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner