Provider Demographics
NPI:1528532397
Name:GENERELLI, JILL MARIE (APN)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:GENERELLI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:DR
Other - First Name:ADRIAN
Other - Middle Name:MICHAEL
Other - Last Name:PRISTAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-8550
Mailing Address - Fax:910-343-1924
Practice Address - Street 1:1333 S DICKINSON DR UNIT 230
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6434
Practice Address - Country:US
Practice Address - Phone:910-662-8550
Practice Address - Fax:910-343-1924
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00896300363LG0600X
NC5019395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology