Provider Demographics
NPI:1346779626
Name:MANNG, JILLIAN (AGNP-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MANNG
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 145
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5102
Mailing Address - Country:US
Mailing Address - Phone:480-607-0606
Mailing Address - Fax:
Practice Address - Street 1:11000 N. SCOTTSDALE RD.
Practice Address - Street 2:#145
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:480-607-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner