Provider Demographics
NPI:1710407358
Name:NATI, JILLIAN (FNP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:NATI
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 1:1103 ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-9738
Mailing Address - Country:US
Mailing Address - Phone:646-962-5558
Mailing Address - Fax:
Practice Address - Street 1:1103 ROUTE 46
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9738
Practice Address - Country:US
Practice Address - Phone:646-962-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14858600363LF0000X
NY669393163W00000X
NYF342630-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse