Provider Demographics
NPI:1609303379
Name:DIERKS, JILL DENISE (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DENISE
Last Name:DIERKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ROCK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-3102
Mailing Address - Country:US
Mailing Address - Phone:319-283-2651
Mailing Address - Fax:
Practice Address - Street 1:9947 W HAPPY VALLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1222
Practice Address - Country:US
Practice Address - Phone:623-434-5748
Practice Address - Fax:623-566-9665
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP10109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZN/AOtherN/A