Healthcare Provider Details

I. General information

NPI: 1023048675
Provider Name (Legal Business Name): JILL A HOLLAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE 202
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

19636 N 27TH AVE SUITE 202
PHOENIX AZ
85027-4013
US

V. Phone/Fax

Practice location:
  • Phone: 623-869-5000
  • Fax: 623-869-0927
Mailing address:
  • Phone: 623-869-5000
  • Fax: 623-869-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP1367
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: