Provider Demographics
NPI:1295299220
Name:HILLS, JESSICA JOHNSON (FNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JOHNSON
Last Name:HILLS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 HAND AVE STE K
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8195
Mailing Address - Country:US
Mailing Address - Phone:386-671-2771
Mailing Address - Fax:386-671-6458
Practice Address - Street 1:1400 HAND AVE STE K
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-671-2771
Practice Address - Fax:386-671-6458
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF011907777363LF0000X
FL11001564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily