Provider Demographics
NPI:1679975700
Name:LOZANOFF, JILLIAN (APRN, FNP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:LOZANOFF
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 HERITAGE PARK BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5674
Mailing Address - Country:US
Mailing Address - Phone:801-335-4114
Mailing Address - Fax:833-569-5678
Practice Address - Street 1:880 HERITAGE PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5674
Practice Address - Country:US
Practice Address - Phone:801-335-4114
Practice Address - Fax:833-569-5678
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10376636-4405363LF0000X
WAAP60497304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily