Provider Demographics
NPI:1649642836
Name:HILLS, JENNA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:HILLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6281 CEDAR CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9637
Mailing Address - Country:US
Mailing Address - Phone:315-263-5147
Mailing Address - Fax:
Practice Address - Street 1:22 WATERBURY DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2719
Practice Address - Country:US
Practice Address - Phone:315-263-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602795-1163W00000X
NYF339788-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse