Provider Demographics
NPI:1265691620
Name:PEREZ, JILLIAN ANDERSON (PA-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ANDERSON
Last Name:PEREZ
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 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3003
Mailing Address - Country:US
Mailing Address - Phone:203-466-5070
Mailing Address - Fax:203-466-5075
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3003
Practice Address - Country:US
Practice Address - Phone:203-466-5070
Practice Address - Fax:203-466-5075
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant