Provider Demographics
NPI:1720621964
Name:GARDNER, JACQUELINE ASHLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ASHLEY
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:8155 PINEY RIVER AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-8728
Practice Address - Country:US
Practice Address - Phone:303-265-3370
Practice Address - Fax:303-265-3371
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.005975363A00000X
CO00005975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant