Provider Demographics
NPI:1821644808
Name:ALLEN, JENNIFER AILEEN (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AILEEN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 MOUNTAIN TURTLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3916
Mailing Address - Country:US
Mailing Address - Phone:719-660-9738
Mailing Address - Fax:
Practice Address - Street 1:11551 MOUNTAIN TURTLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3916
Practice Address - Country:US
Practice Address - Phone:719-660-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK148742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily