MR. KYLE MATTHEW HILLIS (NPI# 1063921955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063921955 |
| Entity Type | Individual |
| Full Name | MR. KYLE MATTHEW HILLIS |
| Credential | CAA |
| Practice Address |
820 Prudential Dr Ste 606 Jacksonville FL 32207-8208 |
| Mailing Address |
5201 Atlantic Blvd Unit 234 Jacksonville FL 32207-2434 |
| Practice Telephone | 9043983356 |
| Mailing Telephone | 9128561098 |
| Enumeration Date | 2017-09-24 |
| Last Update Date | 2017-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
820 PRUDENTIAL DR STE 606 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32207-8208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659705655 | Jessica Hyams Kennedy | Anesthesiologist Assistant | 820 Prudential Dr Ste 606, Jacksonville, FL 32207-8208 | 2013-08-26 |
| 1710497300 | Nour Kablaoui | Anesthesiology | 820 Prudential Dr Ste 606, Jacksonville, FL 32207-8208 | 2017-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1578117024 | Pragna Mukesh Dholakia | Nurse Practitioner | 2624 Atlantic Blvd., Jacksonville, FL 32207 | 2019-08-01 |
| 1821653601 | The Adoption Authority, Inc. | Case Management | 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 | 2019-05-07 |
| 1255896080 | Elizabeth Lynn Houghton | Social Worker | Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 | 2019-02-06 |
| 1902374630 | Guilherme Jose Agnoletto | Neurological Surgery | 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 | 2018-11-12 |
| 1073008504 | Pavilion Infusion Therapy Inc | Durable Medical Equipment & Medical Supplies | 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 | 2018-06-27 |
| 1346733185 | Dueseason1 | Registered Nurse | 4058 Saint Augustine Rd, Jacksonville, FL 32207 | 2018-06-06 |
| 1164911913 | Eric Lang Poovey | Nurse Practitioner | Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 | 2018-05-08 |
| 1902311046 | Spring Park Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3851 Emerson St Ste 13, Jacksonville, FL 32207 | 2017-12-12 |
| 1295247948 | Emed Urgent and Primary Care Pa | Clinic/Center | 2570 Atlantic Boulevard, Jacksonville, FL 32207 | 2017-11-02 |
| Find all providers in zip 32207 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992327308 | Daniel Le Phan | Anesthesiologist Assistant | 800 Prudential Dr Fl 32207, Jacksonville, FL 32207-8202 | 2020-05-08 |
| 1497395412 | Charles Joshua Thrower | Anesthesiologist Assistant | 1 Shircliff Way # Wat, Jacksonville, FL 32204-4748 | 2020-01-07 |
| 1659856862 | Ian Michael Durham | Anesthesiologist Assistant | 1 Shircliff Way Fl 32204, Jacksonville, FL 32204-4748 | 2018-10-03 |
| 1538535711 | Zeyla Rivero | Anesthesiologist Assistant | 11430 Tiara Way E, Jacksonville, FL 32223-7860 | 2015-08-11 |
| 1902206584 | Maria Williamson | Anesthesiologist Assistant | 1815 Bayard Pl, Jacksonville, FL 32205-8803 | 2014-09-02 |
| 1659705655 | Jessica Hyams Kennedy | Anesthesiologist Assistant | 820 Prudential Dr Ste 606, Jacksonville, FL 32207-8208 | 2013-08-26 |
| 1194003228 | Miguel Mancao IIi | Anesthesiologist Assistant | 10199 Southside Blvd Ste 101, Jacksonville, FL 32256-0757 | 2011-07-22 |
| 1285247411 | Victoria Potts | Anesthesiologist Assistant | 4201 Belfort Rd, Jacksonville, FL 32216-1431 | 2020-08-27 |
| 1760090302 | Matthew Ryan Jones | Anesthesiologist Assistant | 800 Prudential Dr, Jacksonville, FL 32207-8202 | 2020-07-20 |
| 1295353407 | Taylor Rush Cowart | Anesthesiologist Assistant | 800 Prudential Dr, Jacksonville, FL 32207-8202 | 2020-07-14 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.