Provider Demographics
NPI:1124190574
Name:MCINTYRE, JILL (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MATERAZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,APN-C
Mailing Address - Street 1:326 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1372
Mailing Address - Country:US
Mailing Address - Phone:609-390-2965
Mailing Address - Fax:
Practice Address - Street 1:618 N SHORE ROAD
Practice Address - Street 2:
Practice Address - City:BEESLEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08223-1737
Practice Address - Country:US
Practice Address - Phone:609-390-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09649200363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051758Medicare PIN
NJP41850Medicare UPIN