Provider Demographics
NPI:1841709482
Name:JENIK, SARAH MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:JENIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 BISON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1541
Mailing Address - Country:US
Mailing Address - Phone:970-551-0138
Mailing Address - Fax:
Practice Address - Street 1:190 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:KEENESBERG
Practice Address - State:CO
Practice Address - Zip Code:80643
Practice Address - Country:US
Practice Address - Phone:303-732-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993415-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner