Provider Demographics
NPI:1326680125
Name:JENSEN, SIMONE TOFT (PA)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:TOFT
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 N NEVADA AVE STE 4004
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6832
Mailing Address - Country:US
Mailing Address - Phone:719-471-7064
Mailing Address - Fax:719-776-5459
Practice Address - Street 1:2222 N NEVADA AVE STE 4004
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6832
Practice Address - Country:US
Practice Address - Phone:719-471-7064
Practice Address - Fax:719-776-5459
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006821363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical