Provider Demographics
NPI:1427236652
Name:VILLAROSA, JILL SUZANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:SUZANNE
Last Name:VILLAROSA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:400 CELEBRATION PL
Mailing Address - Street 2:STE A140
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4970
Mailing Address - Country:US
Mailing Address - Phone:407-303-4602
Mailing Address - Fax:407-303-4603
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:STE A140
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-4602
Practice Address - Fax:407-303-4603
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH2357363AS0400X
FLPA9104340363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant