Provider Demographics
NPI:1669945663
Name:STORMENT, JILL S (AGPCNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:STORMENT
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 SHARON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:KING WILLIAM
Mailing Address - State:VA
Mailing Address - Zip Code:23086-3344
Mailing Address - Country:US
Mailing Address - Phone:804-769-3096
Mailing Address - Fax:804-769-3170
Practice Address - Street 1:1041 SHARON RD STE 205
Practice Address - Street 2:
Practice Address - City:KING WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:23086-3344
Practice Address - Country:US
Practice Address - Phone:804-769-3096
Practice Address - Fax:804-769-3170
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177236363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health