Provider Demographics
NPI:1407864267
Name:MUNTZ, JILL ANDERSON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANDERSON
Last Name:MUNTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9224
Mailing Address - Country:US
Mailing Address - Phone:716-483-4376
Mailing Address - Fax:716-483-4278
Practice Address - Street 1:350 E 2ND ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5623
Practice Address - Country:US
Practice Address - Phone:716-483-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011923363LF0000X
NY332418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily