Provider Demographics
NPI:1144842162
Name:LUNN, JILLIANN RAE
Entity type:Individual
Prefix:
First Name:JILLIANN
Middle Name:RAE
Last Name:LUNN
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 1:3520 56TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-1849
Mailing Address - Country:US
Mailing Address - Phone:607-744-1631
Mailing Address - Fax:
Practice Address - Street 1:3520 56TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-1849
Practice Address - Country:US
Practice Address - Phone:607-744-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL377493251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health