Provider Demographics
NPI:1487783270
Name:SOBCZYK, JILL RENEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENEE
Last Name:SOBCZYK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4601
Mailing Address - Country:US
Mailing Address - Phone:712-396-4340
Mailing Address - Fax:712-396-4180
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5899
Practice Address - Fax:712-322-5730
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001791363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51011042OtherSTATE CONTROLLED SUBSTANC
IA001791OtherLICENSE NUMBER
IA1053300020OtherGROUP NPI NUMBER