Provider Demographics
NPI:1184228934
Name:JASILLI, LAUREN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:JASILLI
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:RUTH
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2760 29TH ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1221
Mailing Address - Country:US
Mailing Address - Phone:303-444-6400
Mailing Address - Fax:303-444-6465
Practice Address - Street 1:2760 29TH ST STE 2B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1221
Practice Address - Country:US
Practice Address - Phone:303-444-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996061-NP363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily