Individual
JILL LISA WOLKSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6716 NW 11TH PLACE, STE 200, GAINESVILLE, FL 32605-4215
(352) 331-9729
(352) 331-0136
Mailing address
6716 NW 11TH PLACE, STE 200, GAINESVILLE, FL 32605-4215
(352) 331-9729
(352) 338-7140
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OS8632
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015061900
—
FL
01
—
13581
BCBS FL
FL
01
—
P01196235
RAILROAD MEDICARE
FL
01
—
P01215410
RAILROAD MEDICARE
FL
Enumeration date
02/14/2006
Last updated
03/08/2022
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