Provider Demographics
NPI:1225543945
Name:TAFOYA, JESUSITA ELVIRA (AGACNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESUSITA
Middle Name:ELVIRA
Last Name:TAFOYA
Suffix:
Gender:F
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHURCHILL PL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2124
Mailing Address - Country:US
Mailing Address - Phone:719-406-5291
Mailing Address - Fax:
Practice Address - Street 1:416 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2011
Practice Address - Country:US
Practice Address - Phone:719-924-9128
Practice Address - Fax:719-924-8053
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993590-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily