Provider Demographics
NPI:1073826764
Name:LE, JACLYN THERESA
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:THERESA
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:THERESA
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7048 S PICADILLY ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2345
Mailing Address - Country:US
Mailing Address - Phone:720-404-2860
Mailing Address - Fax:
Practice Address - Street 1:22175 E HINSDALE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-6009
Practice Address - Country:US
Practice Address - Phone:720-404-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999203363LF0000X
CO194930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse