Provider Demographics
NPI:1205877560
Name:MARSHALL-ALLEN, JILL MARIE (APRN CWS)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:MARSHALL-ALLEN
Suffix:
Gender:
Credentials:APRN CWS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN CWS FACCWS
Mailing Address - Street 1:12250 BLUE PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-1803
Mailing Address - Country:US
Mailing Address - Phone:850-225-8811
Mailing Address - Fax:800-351-2611
Practice Address - Street 1:11806 BRUCE B DOWNS BLVD # 1272
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5542
Practice Address - Country:US
Practice Address - Phone:813-530-9666
Practice Address - Fax:813-729-8645
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1692262163WW0000X, 363L00000X
FLAPRN1692262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9864OtherFL BCBS
FL0009891000Medicaid
FLE4640NMedicare PIN
FL0009891000Medicaid