Provider Demographics
NPI:1609802461
Name:BRILLHART, JENNIFER LEE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:BRILLHART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:BRILLHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6454
Mailing Address - Fax:717-851-1665
Practice Address - Street 1:30 MONUMENT STREET
Practice Address - Street 2:STE 1100
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1740
Practice Address - Country:US
Practice Address - Phone:717-851-6454
Practice Address - Fax:717-851-1665
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002018L363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50040428OtherCAPITAL BLUE CROSS-WMG
PA1550567OtherGATEWAY-WMG
PA50040428OtherCAPITAL BLUE CROSS-WMG
PA083339FLTMedicare PIN
PAS50268Medicare UPIN