Provider Demographics
NPI:1407944580
Name:MUSGRAVE, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:DEMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3000 S COLLEGE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2558
Mailing Address - Country:US
Mailing Address - Phone:970-266-8822
Mailing Address - Fax:970-266-8833
Practice Address - Street 1:3000 S COLLEGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2558
Practice Address - Country:US
Practice Address - Phone:970-266-8822
Practice Address - Fax:970-266-8833
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPAL-2335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant