MEDICARE: MISS JILL SUSAN ERICKSON NURSE PRACTITIONER

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	APRN11022663	FL

General Provider Information

NPI Number	:	1508574419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JILL SUSAN ERICKSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	132 WETTAW LN APT 111
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5685
Country	:	US
Telephone Number	:	772-486-5067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 BROADWAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5433
Country	:	US
Telephone Number	:	772-486-5067
Fax Number	:

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

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	04/17/2024

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