Healthcare Provider Details

I. General information

NPI: 1750367488
Provider Name (Legal Business Name): JILL HAMBURG P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD STE 134
NEWARK DE
19713-2074
US

IV. Provider business mailing address

3200 WINGED ELM DR
CEDAR PARK TX
78613-4384
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-5300
  • Fax:
Mailing address:
  • Phone: 512-923-5179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC11-0000001
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063269
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number59981
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085008335
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02777
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: