Provider Demographics
NPI:1093823361
Name:RICE, JILL (APRN PMHNP AND FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:APRN PMHNP AND FNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN PMHNP FNP
Mailing Address - Street 1:PO BOX 68049
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8085
Mailing Address - Country:US
Mailing Address - Phone:469-693-3044
Mailing Address - Fax:
Practice Address - Street 1:3750 HEATHERWOOD DR APT L5
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2272
Practice Address - Country:US
Practice Address - Phone:694-693-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351891363LF0000X
TX676803363LF0000X
NYF404957363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676803OtherLICENSE
NYF351891OtherNY FNP
NYF404957OtherNY PMHNP