Provider Demographics
NPI:1801119383
Name:HAYCOCK, JANAE ILA (CPNP)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:ILA
Last Name:HAYCOCK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:ILA
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9235 CROWN CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8880
Mailing Address - Country:US
Mailing Address - Phone:303-695-7667
Mailing Address - Fax:
Practice Address - Street 1:9235 CROWN CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8880
Practice Address - Country:US
Practice Address - Phone:303-695-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347403-4405363LP0200X
COC-APN.0000260-C-NP363LP0200X
COC-RXN.0000095-C-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics