Provider Demographics
NPI:1215117247
Name:MAGIONCALDA, JILL MELINDA (MSN, APRN, FNP- BC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MELINDA
Last Name:MAGIONCALDA
Suffix:
Gender:
Credentials:MSN, APRN, FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W LAS OLAS BLVD APT 1503S
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7164
Mailing Address - Country:US
Mailing Address - Phone:203-979-2537
Mailing Address - Fax:
Practice Address - Street 1:200 HIGHLAND AVE STE 100B
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1521
Practice Address - Country:US
Practice Address - Phone:973-559-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3348033363LF0000X
SCF4009367A00000X
NJ26NJ00792200363LF0000X
WI149123030363LF0000X
CT004877363LF0000X
SC4009363LF0000X
NY337794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11035627OtherFAMILY NURSE PRACTITIONER