Provider Demographics
NPI:1508828583
Name:HOGLAND, JANICE I (PA C)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:I
Last Name:HOGLAND
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 NORSE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5523
Mailing Address - Country:US
Mailing Address - Phone:720-438-1465
Mailing Address - Fax:
Practice Address - Street 1:14000 E ARAPAHOE RD
Practice Address - Street 2:BLDG C, STE #300
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:720-979-0840
Practice Address - Fax:303-690-5948
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04855841Medicaid
CO04855841Medicaid
471298Medicare ID - Type Unspecified
CO471298Medicare PIN