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NPI Code Detail

MEDICARE: MRS. JILL MELINDA MAGIONCALDA MSN, APRN, FNP- BC

MEDICARE: MRS. JILL MELINDA MAGIONCALDA MSN, APRN, FNP- BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3348033WI
2367A00000XAdvanced Practice MidwifeF4009SC
3363LF0000XFamily Nurse Practitioner26NJ00792200NJ
4363LF0000XFamily Nurse Practitioner149123030WI
5363LF0000XFamily Nurse Practitioner004877CT
6363LF0000XFamily Nurse Practitioner4009SC
7363LF0000XFamily Nurse Practitioner337794NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111035627OTHERFLFAMILY NURSE PRACTITIONER

General Provider Information

NPI Number : 1215117247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILL MELINDA MAGIONCALDA MSN, APRN, FNP- BC
Provider Business Mailing Address
First Line : 600 W LAS OLAS BLVD APT 1503S
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33312-7164
Country : US
Telephone Number : 203-979-2537
Fax Number :
Provider Business Practice Location Address
First Line : 200 HIGHLAND AVE STE 100B
Second Line :
City : GLEN RIDGE
State : NJ
Zip : 07028-1521
Country : US
Telephone Number : 973-559-0081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2007
Last Update Date : 04/16/2025

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