Provider Demographics
NPI:1346234366
Name:BORTNER, JACQUELINE E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:E
Last Name:BORTNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:E
Other - Last Name:SLEMP
Other - Suffix:
Other - Last Name Type:Former Name
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:970-624-4123
Mailing Address - Fax:970-624-2416
Practice Address - Street 1:1400 E BOULDER ST STE 600
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-364-8346
Practice Address - Fax:719-364-8347
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005248B363L00000X, 363LF0000X
COAPN.0990986-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225103OtherJOHNS HOPKINS
PA342796OtherHIGHMARK BLUE SHIELD
MD686550OtherCAREFIRST MD BCBS
CO07627262Medicaid
PA342796OtherHIGHMARK BLUE SHIELD
CO07627262Medicaid
PAP00641380Medicare PIN