Provider Demographics
NPI:1225470651
Name:RHOADES, JILL E (APRNCNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:RHOADES
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2957
Mailing Address - Fax:
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-2957
Practice Address - Fax:614-685-6533
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.14868363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088616Medicaid
OHAPRN.CNP.14868OtherOH LICENSE
12574712OtherCAQH
OH$$$$$$$$$-00OtherOH BWC