Healthcare Provider Details

I. General information

NPI: 1093273872
Provider Name (Legal Business Name): JILLIAN WALKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 KILLINGLY COMMONS DR
DAYVILLE CT
06241-2187
US

IV. Provider business mailing address

7 RENAISSANCE SQ FL 5
WHITE PLAINS NY
10601-3056
US

V. Phone/Fax

Practice location:
  • Phone: 727-601-4513
  • Fax:
Mailing address:
  • Phone: 813-543-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-150755
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13110
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-150755
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: