1588935712 NPI number — JILL M ALLEN ARNP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588935712 NPI number — JILL M ALLEN ARNP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JILL M ALLEN ARNP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588935712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3695 SCENIC HIGHWAY 98 UNIT 1004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESTIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32541-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-225-8811
Provider Business Mailing Address Fax Number:
888-795-0698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3695 SCENIC HIGHWAY 98 UNIT 1004
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESTIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32541-0700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-225-8811
Provider Business Practice Location Address Fax Number:
888-795-0698
Provider Enumeration Date:
01/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
JILL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-225-8811

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1692262 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 1692262 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205877560 . This is a "INDIVIDUAL NPI JILL M. ALLEN ARNP 1205877560" identifier . This identifiers is of the category "OTHER".