Provider Demographics
NPI:1629965066
Name:BOMAR, JILL MARIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:BOMAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 TORREY PINES RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2982
Mailing Address - Country:US
Mailing Address - Phone:979-479-4216
Mailing Address - Fax:
Practice Address - Street 1:124 TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578-2982
Practice Address - Country:US
Practice Address - Phone:979-479-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine