Provider Demographics
NPI:1093094070
Name:PICCOLO, JILL R (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:PICCOLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:KIRCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:540 SOUTH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2774
Mailing Address - Country:US
Mailing Address - Phone:724-261-5610
Mailing Address - Fax:878-295-8532
Practice Address - Street 1:540 SOUTH ST STE 301
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2774
Practice Address - Country:US
Practice Address - Phone:724-261-5610
Practice Address - Fax:878-295-8532
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA466046Medicare PIN