Provider Demographics
NPI:1285858308
Name:WOZNIAK, JILL C (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CROSSFIELD DR STE A
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1845
Mailing Address - Country:US
Mailing Address - Phone:859-873-9843
Mailing Address - Fax:859-873-0972
Practice Address - Street 1:115 CROSSFIELD DR STE A
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1845
Practice Address - Country:US
Practice Address - Phone:859-873-9843
Practice Address - Fax:859-873-0972
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2846P363LA2200X
KY3002846363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP64579Medicare UPIN
KY0076514Medicare ID - Type Unspecified
KY0083115Medicare ID - Type Unspecified