Provider Demographics
NPI:1821754409
Name:SECUNDE, JILL MARGARET
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARGARET
Last Name:SECUNDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 LINDA SUE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-2113
Mailing Address - Country:US
Mailing Address - Phone:772-985-0569
Mailing Address - Fax:
Practice Address - Street 1:2107 LINDA SUE CIR APT 101
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-2113
Practice Address - Country:US
Practice Address - Phone:772-985-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion