Individual
JEFFREY JOSEPH ILLINIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
2060 GATOR BLVD, VIRGINIA BEACH, VA 23459-8916
(757) 763-4150
Mailing address
2060 GATOR BLVD, VIRGINIA BEACH, VA 23459-8916
(757) 763-4150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110005844
VA
Other
Enumeration date
09/27/2017
Last updated
01/19/2023
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