Provider Demographics
NPI:1972721629
Name:TOLIA, JILL (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:TOLIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 SUMMIT CENTRE WAY UNIT 3212
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6329
Mailing Address - Country:US
Mailing Address - Phone:973-615-4974
Mailing Address - Fax:
Practice Address - Street 1:410 FERN DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7008
Practice Address - Country:US
Practice Address - Phone:352-218-8200
Practice Address - Fax:352-435-0690
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME153272207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112324100Medicaid