Provider Demographics
NPI:1417563602
Name:PUJOLS, JEILA STEPHANIE
Entity type:Individual
Prefix:
First Name:JEILA
Middle Name:STEPHANIE
Last Name:PUJOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5463
Mailing Address - Country:US
Mailing Address - Phone:863-385-2606
Mailing Address - Fax:863-385-7723
Practice Address - Street 1:130 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5463
Practice Address - Country:US
Practice Address - Phone:863-385-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty