Provider Demographics
NPI:1356897565
Name:ARTIS, JILLIAN C (CNM)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:C
Last Name:ARTIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:17000 PORTER RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8915
Mailing Address - Country:US
Mailing Address - Phone:407-635-3058
Mailing Address - Fax:407-636-7826
Practice Address - Street 1:17000 PORTER RD STE 206
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:407-635-3058
Practice Address - Fax:407-636-7826
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9429052367A00000X
FLARNP9429052363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018723700Medicaid