Provider Demographics
NPI:1528110889
Name:ROBARDS, JILL R (FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:ROBARDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7726
Mailing Address - Country:US
Mailing Address - Phone:512-942-4104
Mailing Address - Fax:
Practice Address - Street 1:2000 SCENIC DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7726
Practice Address - Country:US
Practice Address - Phone:512-942-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642707363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187643501Medicaid
TX187643501Medicaid
P00385399Medicare PIN
TX8J3715Medicare PIN