Healthcare Provider Details

I. General information

NPI: 1225635238
Provider Name (Legal Business Name): JESSICA IRENE HERNANDEZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INVERNESS DR E STE 240
ENGLEWOOD CO
80112-5138
US

IV. Provider business mailing address

125 INVERNESS DR E STE 240
ENGLEWOOD CO
80112-5138
US

V. Phone/Fax

Practice location:
  • Phone: 303-357-4014
  • Fax:
Mailing address:
  • Phone: 303-357-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0995886-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number59321
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number1634611
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.0995886-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number59321
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: