Provider Demographics
NPI:1700201589
Name:GAUGHAN, JENNIFER (MS, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GAUGHAN
Suffix:
Gender:F
Credentials:MS, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 S POPLAR ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1362
Mailing Address - Country:US
Mailing Address - Phone:720-442-3615
Mailing Address - Fax:
Practice Address - Street 1:3540 S POPLAR ST STE 202
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1362
Practice Address - Country:US
Practice Address - Phone:720-442-3615
Practice Address - Fax:720-870-3726
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0182070363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77830059Medicaid