Provider Demographics
NPI:1508821240
Name:MUSE, JILL A (ANP CDE)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:MUSE
Suffix:
Gender:F
Credentials:ANP CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2340
Mailing Address - Country:US
Mailing Address - Phone:631-283-2100
Mailing Address - Fax:631-283-5731
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:BLDG #2
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-283-2100
Practice Address - Fax:631-283-5731
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3023671363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01956638Medicaid
NY01956638Medicare ID - Type Unspecified
NY90N791Medicare ID - Type Unspecified
NY01956638Medicaid