MEDICARE: DR. JILL ANNE KRMPOTIC DNP, AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	AP7909	AZ

General Provider Information

NPI Number	:	1649654179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL ANNE KRMPOTIC DNP, AGACNP-BC

Provider Business Mailing Address
First Line	:	1502 E BERRIDGE LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1750
Country	:	US
Telephone Number	:	480-861-8465
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 E CHAUNCEY LN
Second Line	:	SUITE 205
City	:	PHOENIX
State	:	AZ
Zip	:	85054-5160
Country	:	US
Telephone Number	:	602-553-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	07/14/2015

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