Healthcare Provider Details

I. General information

NPI: 1770099319
Provider Name (Legal Business Name): JILLIAN HERNANDEZ SPRAGUE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

IV. Provider business mailing address

2406 BLUE RIDGE RD STE 100
RALEIGH NC
27607-6692
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-4410
  • Fax: 302-428-4078
Mailing address:
  • Phone: 919-786-5001
  • Fax: 919-786-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLJ-0010479
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLJ-0010479
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5011666
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number310313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: