Basic Information
| Provider Information | |||||||||
| NPI: | 1427067909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARP | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3581 | ||||||||
| Address2: | |||||||||
| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936503581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360871 | ||||||||
| FaxNumber: | 5594365221 | ||||||||
| Practice Location | |||||||||
| Address1: | 322 POSADA LN | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TEMPLETON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934654003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055913344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 569240 | CA | N | Nursing Service Providers | Registered Nurse | 367500000X | NA2675 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 569240 | 01 | CA | CA RN LICENSE | OTHER | 051861 | 01 | CA | CRNA ID | OTHER |