Provider Demographics
NPI:1992085476
Name:FERNANDEZ, JILL CHRISTINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CHRISTINE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4022
Mailing Address - Country:US
Mailing Address - Phone:904-247-1953
Mailing Address - Fax:904-247-9390
Practice Address - Street 1:406 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-4022
Practice Address - Country:US
Practice Address - Phone:904-247-1953
Practice Address - Fax:904-247-9390
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist