Basic Information
| Provider Information | |||||||||
| NPI: | 1982908307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESLER | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAHLMAN | ||||||||
| OtherFirstName: | JILL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 77 W UNDERWOOD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076496884 | ||||||||
| FaxNumber: | 4072457059 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 W UNDERWOOD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076496884 | ||||||||
| FaxNumber: | 4072457059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2010 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9105776 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 003416100 | 05 | FL | MEDICAID | PA9105776 | 01 | FL | MEDICAL LICENSE | OTHER |