Provider Demographics
NPI:1346352721
Name:SARANTHUS, JILL ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:SARANTHUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANNE
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1020 J L WHITE DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4908
Mailing Address - Country:US
Mailing Address - Phone:706-692-2437
Mailing Address - Fax:706-692-6869
Practice Address - Street 1:1020 J L WHITE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4908
Practice Address - Country:US
Practice Address - Phone:706-692-2437
Practice Address - Fax:706-692-6869
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ71394Medicare UPIN