Provider Demographics
NPI:1356627152
Name:COHEN, JENNIFER MARGARET (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARGARET
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
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:970-624-4128
Mailing Address - Fax:970-490-4156
Practice Address - Street 1:1600 MID VALLEY DR UNIT A
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-9006
Practice Address - Country:US
Practice Address - Phone:970-871-9770
Practice Address - Fax:970-871-9771
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003316363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54135532OtherRAILROAD MEDICARE
CO54135532Medicaid
CO54135532Medicaid
COCOAAA2815Medicare PIN
CO478416ZS2TMedicare PIN