Provider Demographics
NPI:1730272477
Name:PANNOZZO, JILLEEN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:JILLEEN
Middle Name:MARIE
Last Name:PANNOZZO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6252 GRAND CYPRESS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463
Mailing Address - Country:US
Mailing Address - Phone:561-733-4469
Mailing Address - Fax:561-733-6858
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-733-4469
Practice Address - Fax:561-733-6858
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS00059282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80920Medicare ID - Type Unspecified
FLF05802Medicare UPIN