Provider Demographics
NPI:1881258432
Name:CLOPP, JILL (FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CLOPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:207 FOOTE AVE.
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7077
Mailing Address - Country:US
Mailing Address - Phone:716-934-3641
Mailing Address - Fax:716-934-7443
Practice Address - Street 1:207 FOOTE AVE.
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7077
Practice Address - Country:US
Practice Address - Phone:716-664-8509
Practice Address - Fax:716-664-8519
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343954-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF343954-1OtherLICENSE