Provider Demographics
NPI:1639562333
Name:HENKHAUS, JACLYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:HENKHAUS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 RINGSBY CT
Mailing Address - Street 2:UNIT102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-4922
Mailing Address - Country:US
Mailing Address - Phone:303-500-1518
Mailing Address - Fax:
Practice Address - Street 1:3455 RINGSBY CT
Practice Address - Street 2:UNIT 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4922
Practice Address - Country:US
Practice Address - Phone:303-500-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201504046NP-PP363L00000X
NVAPRN002683363L00000X
CO09910905-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN002683OtherNV LICENSE