Provider Demographics
NPI:1487951307
Name:HILL, JENNIFER NICHOLE (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:HILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICHOLE
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1222 S ORANGE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1215
Mailing Address - Country:US
Mailing Address - Phone:321-841-3444
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:1222 S ORANGE AVE FL 4
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:321-841-3444
Practice Address - Fax:407-650-1307
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-10320363L00000X
FLAPRN11010975363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111377000Medicaid
CO69753075Medicaid