Healthcare Provider Details

I. General information

NPI: 1326492745
Provider Name (Legal Business Name): JENNINE CHRISTY STAFFORD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 E 38TH AVE
DENVER CO
80207-1630
US

IV. Provider business mailing address

1166 S WILLIAMS ST
DENVER CO
80210-1822
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-2458
  • Fax:
Mailing address:
  • Phone: 305-492-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9280189
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992321-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: