Healthcare Provider Details

I. General information

NPI: 1407379399
Provider Name (Legal Business Name): JENNIFER RENEE HENDERSON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 S POTOMAC ST STE 330
AURORA CO
80012-4512
US

IV. Provider business mailing address

1421 S POTOMAC ST STE 330
AURORA CO
80012-4512
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-2920
  • Fax: 303-997-5225
Mailing address:
  • Phone: 303-953-2920
  • Fax: 303-997-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number0993049
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0993049
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0993049-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: