Provider Demographics
NPI:1396376620
Name:GOSS, JILL D (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:GOSS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:D
Other - Last Name:GOSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:1133 CHOCORUA RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:TAMWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03886-5025
Mailing Address - Country:US
Mailing Address - Phone:603-393-7326
Mailing Address - Fax:
Practice Address - Street 1:3073 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-7101
Practice Address - Country:US
Practice Address - Phone:603-356-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPENDING363LF0000X
NH040280-21390200000X
NH040280-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program