Provider Demographics
NPI:1164898995
Name:NELSON, JILL C (MSN, RN, NP-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:C
Other - Last Name:MARKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, NP-C
Mailing Address - Street 1:3033 STATE RD
Mailing Address - Street 2:STE 204
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3600
Mailing Address - Country:US
Mailing Address - Phone:330-253-9727
Mailing Address - Fax:330-926-5866
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-253-9727
Practice Address - Fax:330-926-5866
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.360863163W00000X
OHCOA.17824-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143881Medicaid
OH0143881Medicaid