Provider Demographics
NPI:1558463166
Name:ISAACS, JILL L (ANP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:ISAACS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:SCHOPPERTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:700 S MYRTLE AVE APT 229
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-8410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-8411
Practice Address - Country:US
Practice Address - Phone:626-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4368363LA2200X
CA95010598363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077295213Medicaid
NE280612Medicare PIN
NE47077295213Medicaid