Provider Demographics
NPI:1689770240
Name:TARRANT, JEANINE M (PAC,NP)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:M
Last Name:TARRANT
Suffix:
Gender:F
Credentials:PAC,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 EMPIRE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2677
Mailing Address - Country:US
Mailing Address - Phone:303-665-8444
Mailing Address - Fax:303-665-8448
Practice Address - Street 1:380 EMPIRE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2677
Practice Address - Country:US
Practice Address - Phone:303-665-8444
Practice Address - Fax:303-665-8848
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO392363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07003924Medicaid
COC809329Medicare PIN