Provider Demographics
NPI:1477545069
Name:FITCH, JACQUELINE A
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:FITCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:FITCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 173862
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-3862
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:10101 RIDGEGATE PARKWAY
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9810
Practice Address - Country:US
Practice Address - Phone:720-225-1900
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO888363AM0700X
COPA.0000888363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37729578Medicaid
COP00302399OtherRAILROAD MEDICARE
CO37729578Medicaid
CO804740Medicare PIN
802646Medicare PIN