Provider Demographics
NPI:1588935712
Name:JILL M ALLEN ARNP LLC
Entity type:Organization
Organization Name:JILL M ALLEN ARNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-225-8811
Mailing Address - Street 1:3695 SCENIC HIGHWAY 98 UNIT 1004
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-0700
Mailing Address - Country:US
Mailing Address - Phone:850-225-8811
Mailing Address - Fax:888-795-0698
Practice Address - Street 1:3695 SCENIC HIGHWAY 98 UNIT 1004
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-0700
Practice Address - Country:US
Practice Address - Phone:850-225-8811
Practice Address - Fax:888-795-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1692262363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205877560OtherINDIVIDUAL NPI JILL M. ALLEN ARNP 1205877560