Provider Demographics
NPI:1205092434
Name:GRANT, JILLIAN M (APRN)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1095 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3454
Mailing Address - Country:US
Mailing Address - Phone:860-225-6064
Mailing Address - Fax:860-229-1072
Practice Address - Street 1:1095 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3454
Practice Address - Country:US
Practice Address - Phone:860-225-6064
Practice Address - Fax:860-229-1072
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003836363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics