Provider Demographics
NPI:1861867632
Name:BROGDON, JILL MARIE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:BROGDON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12650 W 64TH AVE
Mailing Address - Street 2:STE. E-501
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3893
Mailing Address - Country:US
Mailing Address - Phone:303-431-4127
Mailing Address - Fax:
Practice Address - Street 1:12650 W 64TH AVE
Practice Address - Street 2:UNIT 501
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3893
Practice Address - Country:US
Practice Address - Phone:303-431-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0162674163W00000X
CO0991927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse