Provider Demographics
NPI:1235626466
Name:GALLEGOS, JODIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:GALLEGOS
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 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2403
Mailing Address - Fax:
Practice Address - Street 1:2773 JANITELL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4102
Practice Address - Country:US
Practice Address - Phone:719-365-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2024-02-15
Deactivation Date:2021-03-31
Deactivation Code:
Reactivation Date:2021-05-03
Provider Licenses
StateLicense IDTaxonomies
CO993624363LF0000X
CO179053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse