Provider Demographics
NPI:1720104649
Name:ANTELL, JILL (WHNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ANTELL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:TUNNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP, WHNP-BC
Mailing Address - Street 1:6283 CLARK RD STE 5
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4100
Mailing Address - Country:US
Mailing Address - Phone:530-872-2000
Mailing Address - Fax:530-332-1049
Practice Address - Street 1:6283 CLARK RD STE 5
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4100
Practice Address - Country:US
Practice Address - Phone:530-872-2000
Practice Address - Fax:530-332-1049
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN 178779363L00000X
AZTRN170433363LX0001X
CANP95026011363LX0001X
NV825017363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner