Basic Information
| Provider Information | |||||||||
| NPI: | 1215392774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASCIA | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | ARNP/FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 SW 14TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333127547 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4725 NORTH FEDERAL HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FLORIDA (FL) | ||||||||
| PostalCode: | 33308 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 9547718000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2015 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 9319300 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.