Healthcare Provider Details

I. General information

NPI: 1851435556
Provider Name (Legal Business Name): JACQUELYN F COBB R.N. CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

20152 E BATAVIA DR
AURORA CO
80011-5424
US

V. Phone/Fax

Practice location:
  • Phone: 303-764-4739
  • Fax:
Mailing address:
  • Phone: 720-216-0030
  • Fax: 303-861-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number83259
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: