Healthcare Provider Details

I. General information

NPI: 1659900629
Provider Name (Legal Business Name): JILL TONNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL KANNEY MD

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

1726 NEW HANOVER MEDICAL PARK DR
WILMINGTON NC
28403-5344
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-7000
  • Fax: 910-667-5650
Mailing address:
  • Phone: 910-662-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD-25390-0
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number261371
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: