Provider Demographics
NPI:1679859482
Name:JACOBY, AIMEE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:ELIZABETH
Last Name:JACOBY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 EAST 3RD ST SUITE #301
Mailing Address - Street 2:PEDIATRIC PARTNERS OF THE SOUTHWEST
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-375-0100
Mailing Address - Fax:970-375-9210
Practice Address - Street 1:810 EAST 3RD ST, SUITE #301
Practice Address - Street 2:PEDIATRIC PARTNERS OF THE SOUTHWEST
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-375-0100
Practice Address - Fax:970-375-9210
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-3283363A00000X
CO3283208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant