Provider Demographics
NPI:1871769851
Name:PURPURA, JILL MARIE
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:PURPURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:PURPURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3167 EDGEMERE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-1123
Mailing Address - Country:US
Mailing Address - Phone:585-746-2599
Mailing Address - Fax:
Practice Address - Street 1:3167 EDGEMERE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-1123
Practice Address - Country:US
Practice Address - Phone:585-746-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily