Provider Demographics
NPI:1902946213
Name:STOKES, JILL BAJUS
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:BAJUS
Last Name:STOKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 JULINGTON CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-3714
Mailing Address - Country:US
Mailing Address - Phone:904-591-0799
Mailing Address - Fax:904-683-4266
Practice Address - Street 1:3667 JULINGTON CREEK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-3714
Practice Address - Country:US
Practice Address - Phone:904-591-0799
Practice Address - Fax:904-683-4266
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL882353700Medicaid