Provider Demographics
NPI:1619695764
Name:D'AMORE, JILLIAN (AGPCNP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:D'AMORE
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1889
Mailing Address - Country:US
Mailing Address - Phone:781-952-1280
Mailing Address - Fax:781-340-1610
Practice Address - Street 1:541 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1889
Practice Address - Country:US
Practice Address - Phone:781-952-1280
Practice Address - Fax:781-340-1610
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264099163WG0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice