Provider Demographics
NPI:1164611752
Name:HAM, JILL ANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:HAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1702
Mailing Address - Country:US
Mailing Address - Phone:703-726-9720
Mailing Address - Fax:703-726-9721
Practice Address - Street 1:19465 DEERFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1702
Practice Address - Country:US
Practice Address - Phone:703-726-9720
Practice Address - Fax:703-726-9721
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002526A363LF0000X
VA0024173256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00833898OtherRAILROAD MEDICARE
IN200888840Medicaid
237770FMedicare PIN