Healthcare Provider Details

I. General information

NPI: 1114315520
Provider Name (Legal Business Name): JESSICA HILL RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JOHN MUIR PKWY SUITE 105
BRENTWOOD CA
94513-5183
US

IV. Provider business mailing address

350 JOHN MUIR PKWY SUITE 105
BRENTWOOD CA
94513-5183
US

V. Phone/Fax

Practice location:
  • Phone: 925-513-2483
  • Fax: 925-513-4957
Mailing address:
  • Phone: 925-513-2483
  • Fax: 925-513-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number836075
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: