Provider Demographics
NPI:1689708018
Name:SIMPSON, JAKE (FNP)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2210
Mailing Address - Country:US
Mailing Address - Phone:303-786-7050
Mailing Address - Fax:
Practice Address - Street 1:255 UNION BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1810
Practice Address - Country:US
Practice Address - Phone:303-936-7415
Practice Address - Fax:303-936-2177
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO114902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily