Provider Demographics
NPI:1568416089
Name:PHOENIX, JILL ANNETTE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNETTE
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:CRNA
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 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43195367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151676704Medicaid
TXAMERIGROUP-10013918OtherJILL PHOENIX, CRNA
TXP01446709OtherRR
TX151676711Medicaid
TX8790UGOtherBCBS
TXBLUE CROSS-82625UOtherJILL PHOENIX, CRNA
TX151676701Medicaid
TX151676711Medicaid
TX151676704Medicaid
TXBLUE CROSS-82625UOtherJILL PHOENIX, CRNA
TX8790UGOtherBCBS
TXAMERIGROUP-10013918OtherJILL PHOENIX, CRNA
TX151676709Medicaid
TXTXB136516Medicare PIN
TX151676704Medicaid
TX8011UUOtherBCBS
TXTXB106534Medicare PIN
TX151676708Medicaid
TX151676707Medicaid