Provider Demographics
NPI:1629352240
Name:EVARTS, JILLIAN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:M
Last Name:EVARTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:M
Other - Last Name:MARTINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-558-2140
Practice Address - Fax:570-558-2141
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant