Provider Demographics
NPI:1487634598
Name:HOLBROOK, JILL NADINE (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:NADINE
Last Name:HOLBROOK
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 1:5981 W BRIDLE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9507
Mailing Address - Country:US
Mailing Address - Phone:520-744-1926
Mailing Address - Fax:
Practice Address - Street 1:6620 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-296-3240
Practice Address - Fax:520-296-3249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN028554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ504854OtherANCCCS
29130Medicare ID - Type Unspecified
S88646Medicare UPIN