Provider Demographics
NPI:1356528228
Name:SULLIVAN, JILL MARIE (MS, PA-C)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 WASHINGTON ST
Mailing Address - Street 2:CARDIOLOGY - 2B
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3322
Mailing Address - Country:US
Mailing Address - Phone:860-545-9400
Mailing Address - Fax:860-545-9410
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:CARDIOLOGY - 2B
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9400
Practice Address - Fax:860-545-9410
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00131300363A00000X
PAMA-052098363AS0400X
NY010073363A00000X
CT2921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical