Provider Demographics
NPI:1326120692
Name:BRABANT, JILL A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:BRABANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 CAPITOL CIRCLE NE
Mailing Address - Street 2:APALACHEE CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-523-3333
Mailing Address - Fax:850-523-3413
Practice Address - Street 1:28 WILLIAM ST.
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1405
Practice Address - Country:US
Practice Address - Phone:315-287-2811
Practice Address - Fax:315-287-4743
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003670-1101YM0800X
NY003670101YM0800X
NYF401307-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53558CMedicare ID - Type Unspecified