Healthcare Provider Details

I. General information

NPI: 1073445078
Provider Name (Legal Business Name): JAI LOUELLA SERGUIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 AURORA CT
AURORA CO
80045-2517
US

IV. Provider business mailing address

16141 BOLLING DR
DENVER CO
80239-5548
US

V. Phone/Fax

Practice location:
  • Phone: 719-331-1893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1679973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: