Provider Demographics
NPI:1144302860
Name:SHEILS, JILL MARIE (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:SHEILS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:LAURICELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7351 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-7107
Mailing Address - Country:US
Mailing Address - Phone:954-749-6955
Mailing Address - Fax:
Practice Address - Street 1:260 SW 84TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2715
Practice Address - Country:US
Practice Address - Phone:954-370-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP39995Medicare UPIN