Healthcare Provider Details

I. General information

NPI: 1881567485
Provider Name (Legal Business Name): JEFFREY MORRIS COFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BASELINE RD STE 300
BOULDER CO
80303-2669
US

IV. Provider business mailing address

4770 BASELINE RD STE 300
BOULDER CO
80303-2669
US

V. Phone/Fax

Practice location:
  • Phone: 720-798-4516
  • Fax: 617-507-1426
Mailing address:
  • Phone: 720-798-4516
  • Fax: 617-507-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1001230-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: