Provider Demographics
NPI:1285087973
Name:CUCINELLA, JILL M (FNP-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:CUCINELLA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:FRISZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:406 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1340
Mailing Address - Country:US
Mailing Address - Phone:812-885-6950
Mailing Address - Fax:812-885-6951
Practice Address - Street 1:406 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1340
Practice Address - Country:US
Practice Address - Phone:812-885-6950
Practice Address - Fax:812-885-6951
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006392A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201375380Medicaid
IN000001039566OtherANTHEM
IN000001039566OtherANTHEM