Provider Demographics
NPI:1902232317
Name:RANDAL, JILL ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:RANDAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CARNOUSTIE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTO
Mailing Address - State:PA
Mailing Address - Zip Code:15142-1082
Mailing Address - Country:US
Mailing Address - Phone:412-735-6062
Mailing Address - Fax:
Practice Address - Street 1:600 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-3016
Practice Address - Country:US
Practice Address - Phone:412-396-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002760-L363A00000X
PAOA006500363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical