Provider Demographics
NPI:1053586297
Name:BAUMAN, JILL (APRN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 MONTAGUE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1856
Mailing Address - Country:US
Mailing Address - Phone:139-291-5008
Mailing Address - Fax:813-670-3252
Practice Address - Street 1:10116 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1856
Practice Address - Country:US
Practice Address - Phone:813-929-1500
Practice Address - Fax:813-670-3252
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9189078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL551ZMedicare PIN