Provider Demographics
NPI:1669499588
Name:CAVISH, JILL ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:CAVISH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20052 FERNGLEN DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6016
Mailing Address - Country:US
Mailing Address - Phone:714-780-0750
Mailing Address - Fax:
Practice Address - Street 1:511 N BROOKHURST ST STE 200
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5229
Practice Address - Country:US
Practice Address - Phone:714-780-0750
Practice Address - Fax:714-780-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333491363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health