Healthcare Provider Details

I. General information

NPI: 1306031406
Provider Name (Legal Business Name): JILL TAMSEN MCLEOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 E YOSEMITE AVE STE 100
MERCED CA
95340-8219
US

IV. Provider business mailing address

3349 G STREET SUITE C
MERCED CA
95340
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-7801
  • Fax: 209-722-1572
Mailing address:
  • Phone: 209-580-4638
  • Fax: 209-384-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17692
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19439
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number19439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: