Provider Demographics
NPI:1487354890
Name:CAROLLA, JILLIAN J (APRN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:J
Last Name:CAROLLA
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 1:188 SCHOOL HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-8923
Mailing Address - Country:US
Mailing Address - Phone:304-785-0365
Mailing Address - Fax:
Practice Address - Street 1:1000 COMMERCE PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5475
Practice Address - Country:US
Practice Address - Phone:570-323-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN762265163W00000X
WV75971163W00000X
WV117947363LP0808X
PASP028764363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse