Provider Demographics
NPI:1366800252
Name:HODILL, DYLAN (PA-C)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HODILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W DR. MARTIN LUTHER KING JR. BLVD
Mailing Address - Street 2:STE 460
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-879-4328
Mailing Address - Fax:
Practice Address - Street 1:2727 W DR. MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:STE 460
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-879-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9109021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant