Provider Demographics
NPI:1558122176
Name:KERZNER, JILLIAN RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RENEE
Last Name:KERZNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3084
Mailing Address - Country:US
Mailing Address - Phone:858-369-1509
Mailing Address - Fax:
Practice Address - Street 1:12395 EL CAMINO REAL STE 209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3084
Practice Address - Country:US
Practice Address - Phone:858-369-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant