Provider Demographics
NPI:1952843625
Name:NEWMAN, JILL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LITTLE EASTATOEE RD
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:SC
Mailing Address - Zip Code:29685-2125
Mailing Address - Country:US
Mailing Address - Phone:864-506-1071
Mailing Address - Fax:
Practice Address - Street 1:403 HILLCREST DR STE E
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1207
Practice Address - Country:US
Practice Address - Phone:864-343-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1942853625Medicaid