Healthcare Provider Details

I. General information

NPI: 1285437202
Provider Name (Legal Business Name): JILL ANN DANIELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ST
BALTIMORE MD
21287-0019
US

IV. Provider business mailing address

118 CROYDON RD
BALTIMORE MD
21212-3301
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-6610
  • Fax:
Mailing address:
  • Phone: 347-628-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR167839
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR167839
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: