Healthcare Provider Details

I. General information

NPI: 1487634598
Provider Name (Legal Business Name): JILL NADINE HOLBROOK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 E CARONDELET DR
TUCSON AZ
85710-2119
US

IV. Provider business mailing address

5981 W BRIDLE WAY
TUCSON AZ
85743-9507
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-3240
  • Fax: 520-296-3249
Mailing address:
  • Phone: 520-744-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN028554
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: