Provider Demographics
NPI:1962503730
Name:NIELSEN, JILL M (NP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:M
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-1000
Mailing Address - Country:US
Mailing Address - Phone:706-745-5541
Mailing Address - Fax:706-745-1361
Practice Address - Street 1:374A PAT HARALSON DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8409
Practice Address - Country:US
Practice Address - Phone:706-745-5541
Practice Address - Fax:706-745-1361
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner