Provider Demographics
NPI:1962752808
Name:SHEA, JILL CARTER (RNFA, BSN, CNOR)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:CARTER
Last Name:SHEA
Suffix:
Gender:F
Credentials:RNFA, BSN, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 S FM 549
Mailing Address - Street 2:2504 RIDGE RD SUITE 202
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5958
Mailing Address - Country:US
Mailing Address - Phone:214-924-3324
Mailing Address - Fax:972-772-9561
Practice Address - Street 1:2504 RIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2571
Practice Address - Country:US
Practice Address - Phone:972-974-1017
Practice Address - Fax:972-772-9561
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776311163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant