Provider Demographics
NPI:1295517746
Name:BROWNER, JACOB (PA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BROWNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BASSETT ST APT 708
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6192
Mailing Address - Country:US
Mailing Address - Phone:216-346-5746
Mailing Address - Fax:
Practice Address - Street 1:300 EXEMPLA CIR STE 420
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3496
Practice Address - Country:US
Practice Address - Phone:720-565-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008135363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant