Healthcare Provider Details

I. General information

NPI: 1356055040
Provider Name (Legal Business Name): JESSICA GABBERT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE STE 320
DENVER CO
80220-3922
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-322-0212
  • Fax:
Mailing address:
  • Phone: 719-463-5600
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998285-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: