Individual
JILL MASSENGALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.R.N.P
Contact information
Practice address
11663 COUNTRYWAY BLVD, TAMPA, FL 33626-2739
(813) 891-6310
(813) 891-6889
Mailing address
13000 BRUCE B DOWNS BLVD, (117), TAMPA, FL 33612-4745
(813) 972-2000
(813) 903-4876
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9184657
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093814964
NPI
FL
01
—
ARNP9184657
STATE LINENCE
FL
Enumeration date
09/21/2006
Last updated
05/26/2009
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