Provider Demographics
NPI:1043600992
Name:JORGENSON, TIFFANY (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7875
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80933-7875
Mailing Address - Country:US
Mailing Address - Phone:719-306-2140
Mailing Address - Fax:
Practice Address - Street 1:3803 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4828
Practice Address - Country:US
Practice Address - Phone:719-428-5552
Practice Address - Fax:719-687-9519
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991575367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife