MEDICARE: JILL ANN TRACY NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	18510	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB220941	OTHER	CA	MEDICARE ID

General Provider Information

NPI Number	:	1669466132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ANN TRACY NP-C

Provider Business Mailing Address
First Line	:	2120 GOLDEN HILL RD STE 102
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-7048
Country	:	US
Telephone Number	:	805-434-2900
Fax Number	:	805-434-2928

Provider Business Practice Location Address
First Line	:	2120 GOLDEN HILL RD STE 102
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-7048
Country	:	US
Telephone Number	:	805-434-2900
Fax Number	:	805-434-2928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/04/2026

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