Provider Demographics
NPI:1952115362
Name:BOJACK, HAILEY RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:RENEE
Last Name:BOJACK
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 S CLAYTON WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3303
Mailing Address - Country:US
Mailing Address - Phone:801-414-9639
Mailing Address - Fax:
Practice Address - Street 1:63 N QUEBEC ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7357
Practice Address - Country:US
Practice Address - Phone:720-798-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0009013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant