Healthcare Provider Details

I. General information

NPI: 1073488482
Provider Name (Legal Business Name): JESSICA ROSE MACLEOD APN-NP, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 W DRAKE RD STE 9
FORT COLLINS CO
80526-2882
US

IV. Provider business mailing address

363 W DRAKE RD STE 9
FORT COLLINS CO
80526-2882
US

V. Phone/Fax

Practice location:
  • Phone: 970-961-0630
  • Fax:
Mailing address:
  • Phone: 970-961-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1001971-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: