Healthcare Provider Details

I. General information

NPI: 1952247413
Provider Name (Legal Business Name): JENNIFER LYNNE PERREAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5364 FREEBOOT PT
COLORADO SPRINGS CO
80922-3279
US

IV. Provider business mailing address

5364 FREEBOOT PT
COLORADO SPRINGS CO
80922-3279
US

V. Phone/Fax

Practice location:
  • Phone: 719-200-8585
  • Fax:
Mailing address:
  • Phone: 719-200-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1001908-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: