Provider Demographics
NPI:1588138556
Name:WEIDEMAN, JILL R (ARNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:WEIDEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:CONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8901 E RAINTREE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7110
Mailing Address - Country:US
Mailing Address - Phone:480-733-7600
Mailing Address - Fax:
Practice Address - Street 1:8901 E RAINTREE DR STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7110
Practice Address - Country:US
Practice Address - Phone:480-733-7600
Practice Address - Fax:602-805-2816
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA112235363L00000X
AZ301837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner