Provider Demographics
NPI:1881910651
Name:VANDYKE, JILL DENISE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:DENISE
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:610 CAMPUS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2589
Mailing Address - Country:US
Mailing Address - Phone:276-525-1474
Mailing Address - Fax:276-525-1616
Practice Address - Street 1:610 CAMPUS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2589
Practice Address - Country:US
Practice Address - Phone:276-525-1474
Practice Address - Fax:276-525-1616
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily