1295299220 NPI number — MRS. JESSICA JOHNSON HILLS FNP

Table of content: MRS. JESSICA JOHNSON HILLS FNP (NPI 1295299220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295299220 NPI number — MRS. JESSICA JOHNSON HILLS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLS
Provider First Name:
JESSICA
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
JESSICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295299220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 HAND AVE STE K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-8195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-671-2771
Provider Business Mailing Address Fax Number:
386-671-6458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 HAND AVE STE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-671-2771
Provider Business Practice Location Address Fax Number:
386-671-6458
Provider Enumeration Date:
01/23/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F011907777 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 11001564 , 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)