Provider Demographics
NPI:1003074105
Name:MARKS, JILL M (RN, APN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:MARKS
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:GOESSL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APN
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80040-0876
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007065363LP0200X
CONP-990223363LP0200X
CORN-201694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse