Provider Demographics
NPI:1992773105
Name:BERNHARDT, JILL S (NP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:BERNHARDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:39 NORBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8959
Mailing Address - Country:US
Mailing Address - Phone:585-425-3506
Mailing Address - Fax:585-359-5045
Practice Address - Street 1:2034 LEHIGH STATION RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9616
Practice Address - Country:US
Practice Address - Phone:585-359-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332981363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34192Medicare UPIN
CC6652Medicare ID - Type Unspecified