Healthcare Provider Details

I. General information

NPI: 1134903347
Provider Name (Legal Business Name): JESSICA CUBRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 UNION BLVD STE 110
LAKEWOOD CO
80228-1836
US

IV. Provider business mailing address

4933 S XENON CT
MORRISON CO
80465-1763
US

V. Phone/Fax

Practice location:
  • Phone: 720-536-2100
  • Fax: 720-536-2090
Mailing address:
  • Phone: 317-525-9169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.1648852
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999074-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: