Provider Demographics
NPI:1518234384
Name:MANDL, JEFFREY ANTHONY (ANP-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ANTHONY
Last Name:MANDL
Suffix:
Gender:M
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SUMMIT BLVD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8299
Mailing Address - Country:US
Mailing Address - Phone:303-673-9090
Mailing Address - Fax:303-673-9195
Practice Address - Street 1:433 SUMMIT BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-673-9090
Practice Address - Fax:303-673-9195
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69070865Medicaid
CO69070865Medicaid