Provider Demographics
NPI:1003564964
Name:PRESTON, JILLIAN LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:LYNN
Last Name:PRESTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:LYNN
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:637 NEW JERSEY AVE NE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-6859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 DEFENSE HWY STE 101
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8921
Practice Address - Country:US
Practice Address - Phone:877-461-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily