Provider Demographics
NPI:1669466132
Name:MACHADO, JILL ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:MACHADO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-434-5497
Mailing Address - Fax:805-434-0917
Practice Address - Street 1:350 POSADA LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4060
Practice Address - Country:US
Practice Address - Phone:805-434-5497
Practice Address - Fax:805-434-0917
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB220941OtherMEDICARE ID