Provider Demographics
NPI:1669177838
Name:CREASY, JILLANY (FNP)
Entity type:Individual
Prefix:
First Name:JILLANY
Middle Name:
Last Name:CREASY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JILLANY
Other - Middle Name:
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:25240 HANCOCK AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5997
Mailing Address - Country:US
Mailing Address - Phone:909-773-8500
Mailing Address - Fax:
Practice Address - Street 1:25240 HANCOCK AVE STE 410
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5997
Practice Address - Country:US
Practice Address - Phone:951-405-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner