Healthcare Provider Details

I. General information

NPI: 1356348189
Provider Name (Legal Business Name): JILL MAUREEN PANETTA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 KRAFT RD STE 301
NAPLES FL
34105-5035
US

IV. Provider business mailing address

4121 AMELIA WAY
NAPLES FL
34119-9042
US

V. Phone/Fax

Practice location:
  • Phone: 203-379-7516
  • Fax:
Mailing address:
  • Phone: 203-379-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002564
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002564
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11005244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: