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General NPI Number Information
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NPI Number | 1073269825
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Entity Type | Individual
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Provider Name | JILLIAN MORITZ
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Gender | Female
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 1325 S CONGRESS AVE SUITE 212
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City | BOYNTON BEACH
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State | FL
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Zip | 33426
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Country | UM
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Telephone | 561-886-6901
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Fax |
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Provider Business Mailing Address
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Address Line | 3607 HIGH RIDGE WAY APT 204
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8746
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Country | US
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Telephone | 716-462-7811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11011489
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11011489
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11011489
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License Number State | FL
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