Provider Demographics
NPI:1720210370
Name:TARVER, JILL ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:TARVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:ELIZABETH
Other - Last Name:MUNRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17030 SNOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7133
Mailing Address - Country:US
Mailing Address - Phone:303-913-7191
Mailing Address - Fax:719-487-7847
Practice Address - Street 1:17030 SNOWWOOD DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7133
Practice Address - Country:US
Practice Address - Phone:303-913-7191
Practice Address - Fax:719-487-7847
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129893163W00000X
WY22388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse