MEDICARE: MRS. JILLIAN ELIZABETH GLOVER FNP-C

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	363L00000X	Nurse Practitioner	294674	AZ

General Provider Information

NPI Number	:	1952087173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILLIAN ELIZABETH GLOVER FNP-C

Provider Business Mailing Address
First Line	:	933 N 104TH ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3207
Country	:	US
Telephone Number	:	623-521-1735
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 W GUADALUPE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7487
Country	:	US
Telephone Number	:	480-827-5620
Fax Number	:

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

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	07/14/2023

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