Provider Demographics
NPI:1942747910
Name:FLORES, JILL RENEE (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:RENEE
Last Name:FLORES
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1000 EDGEWATER POINT
Mailing Address - Street 2:#200
Mailing Address - City:LAKE ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-561-8088
Mailing Address - Fax:636-561-1405
Practice Address - Street 1:1000 EDGEWATER POINT
Practice Address - Street 2:#200
Practice Address - City:LAKE ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-561-8088
Practice Address - Fax:636-561-1405
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011037548363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology