Provider Demographics
NPI:1710469440
Name:FLINT, JILLIAN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ROSE
Last Name:FLINT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:PICINICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2412
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:175 S UNION BLVD STE 310
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3126
Practice Address - Country:US
Practice Address - Phone:719-365-1950
Practice Address - Fax:719-365-1951
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022353363A00000X
COPA.0006786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant