Provider Demographics
NPI:1235192865
Name:FORBES, JILL (CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:FORBES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:OCCOQUAN
Mailing Address - State:VA
Mailing Address - Zip Code:22125-0828
Mailing Address - Country:US
Mailing Address - Phone:703-690-8482
Mailing Address - Fax:701-248-9320
Practice Address - Street 1:9107 OAK CHASE CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-3333
Practice Address - Country:US
Practice Address - Phone:703-690-8482
Practice Address - Fax:701-248-9320
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166639363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC018084M75Medicare UPIN
VA00X172M05Medicare UPIN