Provider Demographics
NPI:1154620219
Name:PAHL, JILL RENEE (AP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:PAHL
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9176 BLIND PASS RD
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1303
Mailing Address - Country:US
Mailing Address - Phone:813-469-7086
Mailing Address - Fax:
Practice Address - Street 1:7005 4TH ST N
Practice Address - Street 2:SUITE 3
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5909
Practice Address - Country:US
Practice Address - Phone:727-502-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2941171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist