Provider Demographics
NPI:1952599631
Name:SPECA, JILL R (PA)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:R
Last Name:SPECA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-953-8250
Mailing Address - Fax:314-953-8255
Practice Address - Street 1:11125 DUNN RD STE 301
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-953-8250
Practice Address - Fax:314-953-8255
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2021-02-22
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Provider Licenses
StateLicense IDTaxonomies
IL085003089363A00000X
MO2017017216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant