MEDICARE: JILL NADINE HOLBROOK FNP

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	RN028554	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	504854	OTHER	AZ	ANCCCS

General Provider Information

NPI Number	:	1487634598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL NADINE HOLBROOK FNP

Provider Business Mailing Address
First Line	:	5981 W BRIDLE WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-9507
Country	:	US
Telephone Number	:	520-744-1926
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2119
Country	:	US
Telephone Number	:	520-296-3240
Fax Number	:	520-296-3249

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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