Provider Demographics
NPI:1609422963
Name:SANNO, JILLIAN BLAKE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:BLAKE
Last Name:SANNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6952 WERTZVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1037
Mailing Address - Country:US
Mailing Address - Phone:717-275-4969
Mailing Address - Fax:
Practice Address - Street 1:52 RED HILL CT
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-8706
Practice Address - Country:US
Practice Address - Phone:717-567-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily