Healthcare Provider Details

I. General information

NPI: 1669466132
Provider Name (Legal Business Name): JILL ANN TRACY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ANN TRACY NP-C

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 GOLDEN HILL RD STE 102
PASO ROBLES CA
93446-7048
US

IV. Provider business mailing address

2120 GOLDEN HILL RD STE 102
PASO ROBLES CA
93446-7048
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-2900
  • Fax: 805-434-2928
Mailing address:
  • Phone: 805-434-2900
  • Fax: 805-434-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: