Provider Demographics
NPI:1154139681
Name:HILLENBERG, IAIN JAMES
Entity type:Individual
Prefix:
First Name:IAIN
Middle Name:JAMES
Last Name:HILLENBERG
Suffix:
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 1:608 SILVER BIRCH PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-8424
Mailing Address - Country:US
Mailing Address - Phone:407-212-8456
Mailing Address - Fax:
Practice Address - Street 1:251 MAITLAND AVE STE 116
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4913
Practice Address - Country:US
Practice Address - Phone:407-915-5643
Practice Address - Fax:407-960-2602
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9119564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant