Healthcare Provider Details

I. General information

NPI: 1326201989
Provider Name (Legal Business Name): JACOB TINGLUM M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST SUITE 175
AURORA CO
80012-5455
US

IV. Provider business mailing address

1550 S POTOMAC ST SUITE 175
AURORA CO
80012-5455
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-3277
  • Fax: 303-752-4327
Mailing address:
  • Phone: 303-369-3277
  • Fax: 303-752-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number283
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: