Provider Demographics
NPI:1861948853
Name:JILL PORTER CRNP PA
Entity type:Organization
Organization Name:JILL PORTER CRNP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-430-7247
Mailing Address - Street 1:1310 BELMONT AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4506
Mailing Address - Country:US
Mailing Address - Phone:443-953-1278
Mailing Address - Fax:443-458-0661
Practice Address - Street 1:1310 BELMONT AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4506
Practice Address - Country:US
Practice Address - Phone:410-430-7247
Practice Address - Fax:443-458-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty