Healthcare Provider Details

I. General information

NPI: 1427683598
Provider Name (Legal Business Name): JILL ELIZABETH RACKLIFFE AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST # 8
BOSTON MA
02114-2621
US

IV. Provider business mailing address

85 OAKWOOD DR APT 4
REDWOOD CITY CA
94061-3953
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-2844
  • Fax:
Mailing address:
  • Phone: 510-502-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN2339692
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: