Provider Demographics
NPI:1285961052
Name:TOMELDEN, JENNIFER DEGUZMAN (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DEGUZMAN
Last Name:TOMELDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5624
Mailing Address - Country:US
Mailing Address - Phone:530-872-2000
Mailing Address - Fax:530-332-1049
Practice Address - Street 1:5125 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5624
Practice Address - Country:US
Practice Address - Phone:530-872-2000
Practice Address - Fax:530-332-1049
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60503363A00000X
IL085.003539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085.003539OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION