Individual
MRS. JILL ANNETTE PHOENIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
43195
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151676701
—
TX
05
—
151676704
—
TX
05
—
151676711
—
TX
01
—
8790UG
BCBS
TX
01
—
AMERIGROUP-10013918
JILL PHOENIX, CRNA
TX
01
—
BLUE CROSS-82625U
JILL PHOENIX, CRNA
TX
01
—
P01446709
RR
TX
Enumeration date
05/20/2006
Last updated
06/23/2018
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