Provider Demographics
NPI:1053760637
Name:GILLIS, JESSICA JACQUELINE (CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JACQUELINE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JACQUELINE
Other - Last Name:SEMRAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5681
Mailing Address - Fax:717-544-4665
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5681
Practice Address - Fax:717-544-4665
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily