Healthcare Provider Details

I. General information

NPI: 1922699982
Provider Name (Legal Business Name): JILL EVA PATRICK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 FRIES MILL RD STE N3
TURNERSVILLE NJ
08012-2055
US

IV. Provider business mailing address

188 FRIES MILL RD STE N3
TURNERSVILLE NJ
08012-2055
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-8000
  • Fax: 856-875-8494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01045600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: