Provider Demographics
NPI:1548389075
Name:DOUGLAS, JILL ANN (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:308 GIBBS POND RD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2200
Mailing Address - Country:US
Mailing Address - Phone:631-444-4793
Mailing Address - Fax:631-444-4695
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CTR
Practice Address - Street 2:HSC T-15 RM080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8153
Practice Address - Country:US
Practice Address - Phone:631-444-4793
Practice Address - Fax:631-444-4695
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF332162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily