Provider Demographics
NPI:1649333550
Name:KARDOUSLY, JILL ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:KARDOUSLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 N HARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3709
Mailing Address - Country:US
Mailing Address - Phone:714-538-6787
Mailing Address - Fax:
Practice Address - Street 1:11110 ALONDRA BLVD
Practice Address - Street 2:CERRITOS COLLEGE STUDENT HEALTH SERVICES
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6203
Practice Address - Country:US
Practice Address - Phone:562-860-2451
Practice Address - Fax:562-467-5076
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMK0832205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily