Active NPI
Jeffrey Joseph Illinik, PHYSICIAN ASSISTANT
- Physician Assistant
- Virginia Beach, VA
National Provider Identifier
1184133670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110005844
- Practice address
- 2060 Gator Blvd
Virginia Beach, VA 23459-8916 - Phone
- (757) 763-4150
- NPI assigned
- Sep 27, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110005844 | VA | Primary |
Addresses
Primary practice location
2060 Gator Blvd
Virginia Beach, VA 23459-8916
Mailing address
2060 Gator Blvd
Virginia Beach, VA 23459-8916
Phone (757) 763-4150
Other names 1
- Jeffrey Joseph Illinik
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110005844 | VA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674086400000",
"number": "1184133670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2060 GATOR BLVD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234598916",
"telephone_number": "757-763-4150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2060 GATOR BLVD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234598916",
"telephone_number": "757-763-4150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILLINIK",
"first_name": "JEFFREY",
"middle_name": "JOSEPH",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-27",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110005844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JEFFREY",
"last_name": "ILLINIK",
"middle_name": "JOSEPH",
"credential": "PA-C",
"code": "2",
"type": "Professional Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.