Provider Demographics
NPI:1952374589
Name:TYLER, JILL K (RN APN-C)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:K
Last Name:TYLER
Suffix:
Gender:F
Credentials:RN APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 N HIGH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2530
Mailing Address - Country:US
Mailing Address - Phone:856-293-7466
Mailing Address - Fax:856-293-7472
Practice Address - Street 1:1203 N HIGH ST
Practice Address - Street 2:UNIT B
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2530
Practice Address - Country:US
Practice Address - Phone:856-293-7466
Practice Address - Fax:856-293-7472
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00020100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11661195OtherCAQH
NJ11661195OtherCAQH
067595QBNMedicare ID - Type Unspecified