Provider Demographics
NPI:1740376953
Name:MOCK, JILL ANNETTE (CNPNP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNETTE
Last Name:MOCK
Suffix:
Gender:F
Credentials:CNPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 MORNING SUN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056
Mailing Address - Country:US
Mailing Address - Phone:513-523-2156
Mailing Address - Fax:513-523-2503
Practice Address - Street 1:5141 MORNING SUN RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056
Practice Address - Country:US
Practice Address - Phone:513-523-2156
Practice Address - Fax:513-523-2503
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP02543363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2044728Medicaid