Healthcare Provider Details

I. General information

NPI: 1922564913
Provider Name (Legal Business Name): JACOB ANDREW ROBERTSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E HAMPDEN AVE STE 470
ENGLEWOOD CO
80113-2797
US

IV. Provider business mailing address

601 E HAMPDEN AVE STE 470
ENGLEWOOD CO
80113-2797
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-3150
  • Fax:
Mailing address:
  • Phone: 303-788-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: