Individual
JILLIAN RENEE HAGERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
17 DAVIS BLVD STE 308, TAMPA, FL 33606-3438
(813) 259-8725
(813) 259-8792
Mailing address
209 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4265
(253) 596-3300
(253) 596-3301
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OP60954917
WA
208000000X
Pediatrics Physician
OS15373
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088500
—
FL
01
—
52225
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/14/2015
Last updated
08/01/2022
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