Provider Demographics
NPI:1982607818
Name:EARL, JILL VAN (CRNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:VAN
Last Name:EARL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 OREGON PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9550
Mailing Address - Country:US
Mailing Address - Phone:717-859-5161
Mailing Address - Fax:717-859-5169
Practice Address - Street 1:3413 HARVEST DR
Practice Address - Street 2:
Practice Address - City:GORDONVILLE
Practice Address - State:PA
Practice Address - Zip Code:17529-9586
Practice Address - Country:US
Practice Address - Phone:717-768-7141
Practice Address - Fax:717-768-3528
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3647470OtherAETNAHMO
PA50038209OtherGRP#/CAPBLUECROSS
PAEA1641588OtherHIGHMARK BLUE SHEILD
PA7233600OtherAETNAPPO/PIN
PA101205598 0001Medicaid
PA50038208OtherID/CAPITOLBLUECROSS
PA50038209OtherGRP#/CAPBLUECROSS
PA101205598 0001Medicaid