Provider Demographics
NPI:1588630107
Name:FONS, JILL SMOLDT (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SMOLDT
Last Name:FONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:SMOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE #100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8013
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:350 INDIANA ST STE 250
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5074
Practice Address - Country:US
Practice Address - Phone:720-898-9427
Practice Address - Fax:303-302-0808
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004821363A00000X
CO2168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ59033Medicare UPIN
COQ59033Medicare UPIN
MIQ59033Medicare UPIN