Provider Demographics
NPI:1043975253
Name:DRISCOLL, JEFFREY (RDN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9566 PANCAKE ROCKS TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2929
Mailing Address - Country:US
Mailing Address - Phone:801-390-7955
Mailing Address - Fax:
Practice Address - Street 1:9566 PANCAKE ROCKS TRL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-2929
Practice Address - Country:US
Practice Address - Phone:801-390-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered