Provider Demographics
NPI:1609542034
Name:MUNIZ, JESSICA TENLEY (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TENLEY
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 W 69TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-3509
Mailing Address - Country:US
Mailing Address - Phone:720-470-1744
Mailing Address - Fax:
Practice Address - Street 1:1743 WALNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5584
Practice Address - Country:US
Practice Address - Phone:303-449-3777
Practice Address - Fax:303-449-3775
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0996695OtherDORA