Provider Demographics
NPI:1104477439
Name:BLOCKER, JILL R (CNA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:R
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0521
Mailing Address - Country:US
Mailing Address - Phone:860-837-1130
Mailing Address - Fax:
Practice Address - Street 1:25 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2065
Practice Address - Country:US
Practice Address - Phone:860-219-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT091303632E376K00000X
CT3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide