=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679128094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASJIT GILL FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2019
-----------------------------------------------------
Last Update Date | 03/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3109 E WHITMORE AVE
-----------------------------------------------------
City | CERES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95307-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-682-4842
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 W CHILDS AVE
-----------------------------------------------------
City | MERCED
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95341-6805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-682-4842
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 95038766
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95012124
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------