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Individual

MRS. JILL F HENRITZE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
811 STATE ST, BRISTOL, VA 24201-4143
(276) 469-8899
(276) 469-8904
Mailing address
811 STATE ST, BRISTOL, VA 24201-4143
(276) 469-8899
(276) 469-8904

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0000001029
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1255376190
VA
05
3661425
TN
01
PA0001029
LICENSE
TN
Enumeration date
06/17/2006
Last updated
03/30/2023
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