Provider Demographics
NPI:1619714003
Name:GILL, JORDYN ROSE (APRN)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:ROSE
Last Name:GILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 GATHERING WAY
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4382
Mailing Address - Country:US
Mailing Address - Phone:908-328-4765
Mailing Address - Fax:
Practice Address - Street 1:2803 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6343
Practice Address - Country:US
Practice Address - Phone:813-253-2273
Practice Address - Fax:813-253-2279
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033907363LF0000X
FL11033907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily