Provider Demographics
NPI:1114910742
Name:WEINGER, JILL S (PA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:WEINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5499 GLEN LAKES DR
Mailing Address - Street 2:#100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4300
Mailing Address - Country:US
Mailing Address - Phone:214-691-1330
Mailing Address - Fax:214-691-6405
Practice Address - Street 1:5499 GLEN LAKES DR
Practice Address - Street 2:#100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4300
Practice Address - Country:US
Practice Address - Phone:214-691-1330
Practice Address - Fax:214-691-6405
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02013363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6511Medicare ID - Type Unspecified
TXQ46831Medicare UPIN