Healthcare Provider Details

I. General information

NPI: 1295806701
Provider Name (Legal Business Name): JILL EILEEN SIMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WINTHROP UNIVERSITY HEALTH 708 OAKLAND AVE. CRAWFORD BLDG.
ROCK HILL SC
29733-0001
US

IV. Provider business mailing address

1202 JOANIES CT
ROCK HILL SC
29732-8844
US

V. Phone/Fax

Practice location:
  • Phone: 803-323-2206
  • Fax:
Mailing address:
  • Phone: 803-980-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN1632
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: