MEDICARE: LEANDER JONES PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	95037260	CA

General Provider Information

NPI Number	:	1881565760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANDER JONES PNP

Provider Business Mailing Address
First Line	:	337 MARIGOLD DR
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-7661
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 JEFFERSON BLVD STE 1
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3343
Country	:	US
Telephone Number	:	916-371-3787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	10/03/2025

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