Provider Demographics
NPI:1508574419
Name:ERICKSON, JILL SUSAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:SUSAN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WETTAW LN APT 111
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5685
Mailing Address - Country:US
Mailing Address - Phone:772-486-5067
Mailing Address - Fax:
Practice Address - Street 1:2700 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5433
Practice Address - Country:US
Practice Address - Phone:772-486-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022663363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology