MEDICARE: JILL FORBES C.N.P.

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
1	363LG0600X	Gerontology Nurse Practitioner	0024166639	VA
2	363LA2200X	Adult Health Nurse Practitioner	0024166639	VA

General Provider Information

NPI Number	:	1235192865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL FORBES C.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 828
Second Line	:
City	:	OCCOQUAN
State	:	VA
Zip	:	22125-0828
Country	:	US
Telephone Number	:	703-690-8482
Fax Number	:	701-248-9320

Provider Business Practice Location Address
First Line	:	9107 OAK CHASE CT
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-3333
Country	:	US
Telephone Number	:	703-690-8482
Fax Number	:	701-248-9320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	12/04/2019

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