Provider Demographics
NPI:1083137202
Name:COSTLOW, JORDAN DENEEN (FNP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:DENEEN
Last Name:COSTLOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2226
Mailing Address - Country:US
Mailing Address - Phone:303-600-3699
Mailing Address - Fax:
Practice Address - Street 1:1445 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2226
Practice Address - Country:US
Practice Address - Phone:303-600-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134095363L00000X
COAPN.0998687-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner