Provider Demographics
NPI:1184228934
Name:JASILLI, LAUREN RUTH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:RUTH
Last Name:JASILLI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:RUTH
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13777 W 76TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-3368
Mailing Address - Country:US
Mailing Address - Phone:904-334-4361
Mailing Address - Fax:
Practice Address - Street 1:13777 W 76TH PL
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3368
Practice Address - Country:US
Practice Address - Phone:904-334-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996061-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily