Healthcare Provider Details

I. General information

NPI: 1861948853
Provider Name (Legal Business Name): JILL PORTER CRNP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 BELMONT AVE SUITE 302
SALISBURY MD
21804-4506
US

IV. Provider business mailing address

1310 BELMONT AVE SUITE 302
SALISBURY MD
21804-4506
US

V. Phone/Fax

Practice location:
  • Phone: 410-430-7247
  • Fax: 443-458-0661
Mailing address:
  • Phone: 443-953-1278
  • Fax: 443-458-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JILL RENEE PORTER
Title or Position: OWNER
Credential: CRNP
Phone: 410-430-7247