Provider Demographics
NPI:1912242330
Name:EIDE, JESSICA ERIN (ACNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:EIDE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 DTC PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2719
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-708-1834
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2719
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-773-3675
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0160563363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31685064Medicaid
CO272236YLMEMedicare PIN