Provider Demographics
NPI:1538441316
Name:WARD, JILL ANGELA (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANGELA
Last Name:WARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 COLLINS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7176
Mailing Address - Country:US
Mailing Address - Phone:904-535-4815
Mailing Address - Fax:
Practice Address - Street 1:5816 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3153
Practice Address - Country:US
Practice Address - Phone:858-775-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5307014169207P00000X
FL110689207P00000X
GA93636207P00000X
FLFW2754655207P00000X
MI4301507937207P00000X
MI5315241184207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003154167DMedicaid
FL008868300Medicaid
FL14PL3OtherBCBS