Healthcare Provider Details

I. General information

NPI: 1235362690
Provider Name (Legal Business Name): LINDA TAMIKO JAGELS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST SUITE 3740
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

9928 HAWKVIEW WAY
ELK GROVE CA
95757-2816
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6510
  • Fax:
Mailing address:
  • Phone: 916-478-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number15759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: