Provider Demographics
NPI:1679183958
Name:TOBILLO, JENNA (RN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:TOBILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 MISSION AVE UNIT 2517
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6852
Mailing Address - Country:US
Mailing Address - Phone:630-577-7037
Mailing Address - Fax:
Practice Address - Street 1:4926 MISSION AVE UNIT 2517
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6852
Practice Address - Country:US
Practice Address - Phone:630-577-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse