Provider Demographics
NPI:1184022717
Name:BROWN, JILL-MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JILL-MARIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W CARVER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-424-3376
Mailing Address - Fax:
Practice Address - Street 1:180 E PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1915
Practice Address - Country:US
Practice Address - Phone:631-425-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307011363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health