Provider Demographics
NPI:1114150331
Name:BROCK, JILL OGLE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:OGLE
Last Name:BROCK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:OGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1450 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3005
Mailing Address - Country:US
Mailing Address - Phone:615-298-8070
Mailing Address - Fax:
Practice Address - Street 1:1450 14TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3005
Practice Address - Country:US
Practice Address - Phone:615-298-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator