Provider Demographics
NPI:1235650151
Name:MARKS, JILLIAN AMANDA (DNP, AGNP)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:AMANDA
Last Name:MARKS
Suffix:
Gender:F
Credentials:DNP, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1108
Mailing Address - Country:US
Mailing Address - Phone:716-882-0366
Mailing Address - Fax:
Practice Address - Street 1:564 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1108
Practice Address - Country:US
Practice Address - Phone:716-882-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308221363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health