Provider Demographics
NPI:1750367488
Name:HAMBURG, JILL (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HAMBURG
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WINGED ELM DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4384
Mailing Address - Country:US
Mailing Address - Phone:512-923-5179
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN STANTON RD STE 134
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2074
Practice Address - Country:US
Practice Address - Phone:302-738-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC11-0000001363AM0700X
PAMA063269363AM0700X
TXPA02777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85N749Medicare PIN
TXP24847Medicare UPIN