Provider Demographics
NPI:1427373208
Name:HARRIS, JILL RENEE (ACNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:RENEE
Other - Last Name:PAYNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:2240 N. HARBOR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-870-4665
Mailing Address - Fax:
Practice Address - Street 1:2240 N. HARBOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-870-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18602363LA2100X
CA3071364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care