Provider Demographics
NPI:1437364023
Name:GILLIS, JENNIFER L (ANP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GILLIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HEALTH LN
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2710
Mailing Address - Country:US
Mailing Address - Phone:401-737-6050
Mailing Address - Fax:401-737-3084
Practice Address - Street 1:51 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2710
Practice Address - Country:US
Practice Address - Phone:401-737-6050
Practice Address - Fax:401-737-3084
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37251363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1065540OtherDEA