Basic Information
| Provider Information | |||||||||
| NPI: | 1629176748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | #1 VILLA OLGA | ||||||||
| Address2: | |||||||||
| City: | ST. THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 00802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407740605 | ||||||||
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| Practice Location | |||||||||
| Address1: | SCHNEIDER REGIONAL MEDICAL CENTER | ||||||||
| Address2: | 9048 SUGAR ESTATE | ||||||||
| City: | ST. THOMAS | ||||||||
| State: | VIRGIN ISLANDS | ||||||||
| PostalCode: | 00802 | ||||||||
| CountryCode: | VG | ||||||||
| TelephoneNumber: | 3407768311 | ||||||||
| FaxNumber: | 3407146322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 004 | VI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 239782300000013 | 01 | VI | PHYSICIAN ASSISTANT | OTHER |