Provider Demographics
NPI:1093490161
Name:FERRETTI, JILL ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:FERRETTI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-9679
Mailing Address - Country:US
Mailing Address - Phone:570-540-6896
Mailing Address - Fax:
Practice Address - Street 1:4 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1602
Practice Address - Country:US
Practice Address - Phone:570-258-3939
Practice Address - Fax:570-735-2921
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP0727275363LF0000X
PASP027275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily