Provider Demographics
NPI:1336478619
Name:VILLA, JILL (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 MADISON AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5855
Mailing Address - Country:US
Mailing Address - Phone:212-873-3420
Mailing Address - Fax:212-937-2279
Practice Address - Street 1:477 MADISON AVE STE 420
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5855
Practice Address - Country:US
Practice Address - Phone:212-873-3420
Practice Address - Fax:212-937-2279
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
FLPA9109981363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical