Jill Forman, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

388306 Issued in CA

Practice address

200 Hillmont Ave
Ventura, CA 93003-1647

Phone

(805) 652-5755

NPI assigned

Jul 3, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215043200000",
    "number": "1770746307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24249",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930024249",
            "telephone_number": "805-652-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HILLMONT AVE",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031647",
            "telephone_number": "805-652-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "JILL",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-03",
        "last_updated": "2008-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "388306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Penny M Foote, PT
• John Joseph Forbito
• Nichole Force, MA
• Lucy K. Ford, LCSW
• Megan Linnea Forgie
• Christopher Fosco, MD
• Douglas G Fosco, MOT, OTR/L, CHT
• Melissa Christine Foster
• Kimberly Andre Fouche, LMFT
• Benjamin Luke Swivel Fowler, MD

• Psychiatric/Mental Health Registered Nurse in Ventura, CA
• Providers in Ventura, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.