Basic Information
| Provider Information | |||||||||
| NPI: | 1114315520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 JOHN MUIR PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945135183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255132483 | ||||||||
| FaxNumber: | 9255134957 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 JOHN MUIR PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945135183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255132483 | ||||||||
| FaxNumber: | 9255134957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2015 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 836075 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95002020 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 95002020 | 01 | CA | CALIFORNIA BOARD OF REGISTERED NURSING - NP | OTHER |