Provider Demographics
NPI:1447298112
Name:WENTZ, JILL REHOVSKY (PAC)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:REHOVSKY
Last Name:WENTZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 NW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1755
Mailing Address - Country:US
Mailing Address - Phone:615-410-4099
Mailing Address - Fax:615-867-1748
Practice Address - Street 1:1340 NW BROAD ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1755
Practice Address - Country:US
Practice Address - Phone:615-410-4099
Practice Address - Fax:615-867-1748
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN849363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3668244Medicare PIN
P01659Medicare UPIN