Healthcare Provider Details

I. General information

NPI: 1477545069
Provider Name (Legal Business Name): JACQUELINE A. FITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE A. FITCH PA

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 RIDGEGATE PARKWAY
LONE TREE CO
80124-9810
US

IV. Provider business mailing address

PO BOX 173862
DENVER CO
80217-3862
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-1900
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number888
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0000888
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: