MEDICARE: JILL JENSEN APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	864100	NV

General Provider Information

NPI Number	:	1407562887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL JENSEN APRN, FNP-C

Provider Business Mailing Address
First Line	:	6488 BLUFF DWELLERS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3027
Country	:	US
Telephone Number	:	702-499-1696
Fax Number	:

Provider Business Practice Location Address
First Line	:	7010 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3123
Country	:	US
Telephone Number	:	702-228-7054
Fax Number	:

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

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	02/13/2023

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