Provider Demographics
NPI:1467494757
Name:JESSEN, TRACY (NP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:JESSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11457 W WOLF TOOTH PASS
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4026
Mailing Address - Country:US
Mailing Address - Phone:217-652-0178
Mailing Address - Fax:
Practice Address - Street 1:12999 W. DEER CREEK CANYON RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127
Practice Address - Country:US
Practice Address - Phone:303-932-5155
Practice Address - Fax:303-932-5115
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP0990073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00129793OtherRAILROAD MEDICARE
COCOA106915Medicare PIN
ILP00129793OtherRAILROAD MEDICARE
ILP98192Medicare UPIN