Healthcare Provider Details

I. General information

NPI: 1174512529
Provider Name (Legal Business Name): JILL A. ZIMMERMAN ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MOCKINGBIRD LN
PIKE ROAD AL
36064-3542
US

IV. Provider business mailing address

445 MOCKINGBIRD LN
PIKE ROAD AL
36064-3542
US

V. Phone/Fax

Practice location:
  • Phone: 828-808-6593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number150968
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9501590
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number60741024
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-053539
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: