Provider Demographics
NPI:1467403402
Name:MINER, JILL HANCOCK (CRNA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:HANCOCK
Last Name:MINER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6306
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9223039367500000X
SC17767367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307194400Medicaid
FLG3909OtherBCBS
P00241305OtherPALMETTO GBA-RR MEDICARE
P00241305OtherPALMETTO GBA-RR MEDICARE