Provider Demographics
NPI:1891506663
Name:GAVASTO, JILL LORRAINE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LORRAINE
Last Name:GAVASTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:LORRAINE
Other - Last Name:PEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:709 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226
Mailing Address - Country:US
Mailing Address - Phone:724-954-3504
Mailing Address - Fax:
Practice Address - Street 1:709 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226
Practice Address - Country:US
Practice Address - Phone:724-954-2504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5264837164W00000X
PA273254164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse