Provider Demographics
NPI:1649654179
Name:KRMPOTIC, JILL ANNE (DNP, AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANNE
Last Name:KRMPOTIC
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 E BERRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1750
Mailing Address - Country:US
Mailing Address - Phone:480-861-8465
Mailing Address - Fax:
Practice Address - Street 1:6910 E CHAUNCEY LN
Practice Address - Street 2:SUITE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5160
Practice Address - Country:US
Practice Address - Phone:602-553-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7909363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care