Provider Demographics
NPI:1306031406
Name:MCLEOD, JILL TAMSEN (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:TAMSEN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 G STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-580-4638
Mailing Address - Fax:209-384-3966
Practice Address - Street 1:388 E YOSEMITE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8219
Practice Address - Country:US
Practice Address - Phone:209-722-7801
Practice Address - Fax:209-722-1572
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17692363LF0000X
CA19439363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant