Provider Demographics
NPI:1922009828
Name:EVANOFF, JAYNA (PHARMD PA C)
Entity Type:Individual
Prefix:
First Name:JAYNA
Middle Name:
Last Name:EVANOFF
Suffix:
Gender:F
Credentials:PHARMD PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 PEARL ST
Mailing Address - Street 2:#203
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4810
Mailing Address - Country:US
Mailing Address - Phone:303-274-1750
Mailing Address - Fax:
Practice Address - Street 1:8515 PEARL ST
Practice Address - Street 2:#203
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4810
Practice Address - Country:US
Practice Address - Phone:303-274-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA-16198183500000X
AZ12461183500000X
CO1642363A00000X
CAPA-16827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76853527Medicaid
COCOAAA4389Medicare PIN
Q37886Medicare UPIN
CO76853527Medicaid