Individual
ELISA KRILL-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1475 NW 12TH AVE FL 32, MIAMI, FL 33136-1002
(305) 243-5302
(305) 243-9161
Mailing address
1475 NW 12TH AVE FL 32, MIAMI, FL 33136-1002
(305) 243-5302
(305) 243-9161
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME66352
FL
207RH0003X
Hematology & Oncology Physician
0066352
FL
207RH0003X
Hematology & Oncology Physician
Primary
ME66352
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272074400
—
FL
Enumeration date
10/07/2005
Last updated
10/31/2019
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