Basic Information
| Provider Information | |||||||||
| NPI: | 1306031406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | TAMSEN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3349 G STREET SUITE C | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095804638 | ||||||||
| FaxNumber: | 2093843966 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 E. YOSEMITE AVE SUITE A | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093849108 | ||||||||
| FaxNumber: | 2093840580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 19439 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LF0000X | 17692 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.