Healthcare Provider Details

I. General information

NPI: 1245941327
Provider Name (Legal Business Name): JISEBELLE TIZON RN CNS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

4003 S NETHERLAND ST
AURORA CO
80013-7454
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-3639
  • Fax:
Mailing address:
  • Phone: 720-323-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN.0990727-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: