Provider Demographics
NPI:1851662332
Name:RODGERS, JILL ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-253-3428
Mailing Address - Fax:724-253-3029
Practice Address - Street 1:3339 PERRY HIGHWAY
Practice Address - Street 2:
Practice Address - City:SHEAKLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:16151
Practice Address - Country:US
Practice Address - Phone:724-253-3428
Practice Address - Fax:724-253-3029
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011471363LF0000X, 363LF0000X
PASP020031363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily