Provider Demographics
NPI:1780081380
Name:RENFRO, JILL SUZANNE (APRN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:RENFRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 S GARNETT RD STE 110
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5216
Mailing Address - Country:US
Mailing Address - Phone:918-927-9191
Mailing Address - Fax:
Practice Address - Street 1:4606 S GARNETT RD STE 110
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5216
Practice Address - Country:US
Practice Address - Phone:918-927-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily