Healthcare Provider Details

I. General information

NPI: 1669466132
Provider Name (Legal Business Name): JILL ANN MACHADO 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: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 POSADA LANE SUITE 202
TEMPLETON CA
93465-4060
US

IV. Provider business mailing address

117 WEST BUNNY AVENUE
SANTA MARIA CA
93458-2805
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5497
  • Fax: 805-434-0917
Mailing address:
  • Phone: 805-434-5497
  • Fax: 805-434-0917

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: