Provider Demographics
NPI:1225627359
Name:PUERTO, JILLIAN MARIE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARIE
Last Name:PUERTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:PUERTO
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:1903 ELMSMERE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4305
Mailing Address - Country:US
Mailing Address - Phone:804-387-8788
Mailing Address - Fax:
Practice Address - Street 1:1903 ELMSMERE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4305
Practice Address - Country:US
Practice Address - Phone:804-387-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001225202163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency