Healthcare Provider Details

I. General information

NPI: 1437966439
Provider Name (Legal Business Name): JILL MARIE SEXTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 FELLER DR
CENTRAL ISLIP NY
11722-1211
US

IV. Provider business mailing address

199 FELLER DR
CENTRAL ISLIP NY
11722-1211
US

V. Phone/Fax

Practice location:
  • Phone: 808-256-1168
  • Fax:
Mailing address:
  • Phone: 808-256-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number814042-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: