Healthcare Provider Details

I. General information

NPI: 1720146947
Provider Name (Legal Business Name): JILL ELIZABETH FRITZ MSN, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ELIZABETH AUTHMUTH MSN, ANP-BC

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S NATIONAL AVE STE 510
SPRINGFIELD MO
65807-5284
US

IV. Provider business mailing address

545 BRANSON LANDING BLVD SUITE 307
BRANSON MO
65616-4500
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3000
  • Fax:
Mailing address:
  • Phone: 417-335-7490
  • Fax: 417-335-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2003005233
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: