Provider Demographics
NPI:1811290307
Name:VOAG, JENNIFER E (MS,, PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:VOAG
Suffix:
Gender:F
Credentials:MS,, PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:HABERKORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:1390 S POTOMAC ST
Mailing Address - Street 2:STE 128
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6165
Mailing Address - Country:US
Mailing Address - Phone:303-341-4785
Mailing Address - Fax:303-341-1479
Practice Address - Street 1:9351 GRANT ST
Practice Address - Street 2:STE 100
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4358
Practice Address - Country:US
Practice Address - Phone:303-280-3893
Practice Address - Fax:303-280-3908
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCL0508Medicare PIN