Healthcare Provider Details

I. General information

NPI: 1922471879
Provider Name (Legal Business Name): JILL MCDONALD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2015
Last Update Date: 10/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S SEMORAN BLVD SUITE 108
WINTER PARK FL
32792-5313
US

IV. Provider business mailing address

147 ROSS RD
GRAMPIAN PA
16838-7818
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-1050
  • Fax: 800-521-9608
Mailing address:
  • Phone: 814-236-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN317041L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: