Healthcare Provider Details

I. General information

NPI: 1164427142
Provider Name (Legal Business Name): JILL ANN FRANCES CRNP.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 LANGHORNE RD
LYNCHBURG VA
24501-1602
US

IV. Provider business mailing address

1376 WARES GAP RD
MONROE VA
24574-2702
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5297
  • Fax:
Mailing address:
  • Phone: 443-775-9879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0024179311
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number24179311
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024179311
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: