Provider Demographics
NPI:1427337666
Name:ROSS, JILLIAN KATHLEEN (APRN)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:KATHLEEN
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 MILL ST
Mailing Address - Street 2:STE 224
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:480-862-1700
Mailing Address - Fax:480-718-7643
Practice Address - Street 1:55 WALLS DR., SUITE 405
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5163
Practice Address - Country:US
Practice Address - Phone:203-259-7070
Practice Address - Fax:203-254-7402
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily