Healthcare Provider Details

I. General information

NPI: 1972983013
Provider Name (Legal Business Name): JILL FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 101TH AVE
COLUMBUS OH
43210
US

IV. Provider business mailing address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8619
  • Fax: 614-293-6420
Mailing address:
  • Phone: 614-293-8619
  • Fax: 614-293-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA17954.NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2284360
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: