Healthcare Provider Details

I. General information

NPI: 1629176748
Provider Name (Legal Business Name): JILL T. ANDERSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCHNEIDER REGIONAL MEDICAL CENTER 9048 SUGAR ESTATE
ST. THOMAS VIRGIN ISLANDS
00802
VG

IV. Provider business mailing address

#1 VILLA OLGA
ST. THOMAS VI
00802
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-8311
  • Fax: 340-714-6322
Mailing address:
  • Phone: 340-774-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: