Healthcare Provider Details

I. General information

NPI: 1790075422
Provider Name (Legal Business Name): JADE MICHELE MAKARENKO CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRYSTAL GROOMS CPNP

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 INTERNATIONAL CIR STE 140
COLORADO SPRINGS CO
80910-3127
US

IV. Provider business mailing address

3205 N ACADEMY BLVD STE 130
COLORADO SPRINGS CO
80917-5152
US

V. Phone/Fax

Practice location:
  • Phone: 719-344-6565
  • Fax:
Mailing address:
  • Phone: 719-344-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number739918
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number739918
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11028321
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC-APN.0107141-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: