Provider Demographics
NPI:1396389011
Name:LUBS, JESSICA (AGCNS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LUBS
Suffix:
Gender:F
Credentials:AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 SLEEPING GIANT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5118
Mailing Address - Country:US
Mailing Address - Phone:719-200-1932
Mailing Address - Fax:
Practice Address - Street 1:6608 SLEEPING GIANT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-5118
Practice Address - Country:US
Practice Address - Phone:719-200-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995130-CNS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist