Provider Demographics
NPI:1114315520
Name:HILL, JESSICA (RN, FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 JOHN MUIR PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5183
Mailing Address - Country:US
Mailing Address - Phone:925-513-2483
Mailing Address - Fax:925-513-4957
Practice Address - Street 1:350 JOHN MUIR PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5183
Practice Address - Country:US
Practice Address - Phone:925-513-2483
Practice Address - Fax:925-513-4957
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA836075163W00000X
CA95002020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95002020OtherCALIFORNIA BOARD OF REGISTERED NURSING - NP