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General NPI Number Information
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NPI Number | 1295084358
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Entity Type | Individual
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Provider Name | JILLIAN EVE LINK PA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 2301 ERWIN RD
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City | DURHAM
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State | NC
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Zip | 27705-4699
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Country | US
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Telephone | 919-385-2362
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 LOVDAL DR
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City | RALEIGH
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State | NC
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Zip | 27613-6871
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Country | US
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Telephone | 774-551-6293
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 015776-1
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License Number State | NY
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