Healthcare Provider Details

I. General information

NPI: 1255825378
Provider Name (Legal Business Name): ADRIANNA DERIN JENSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DRY CREEK DR
LONGMONT CO
80503-6499
US

IV. Provider business mailing address

PO BOX 743749
LOS ANGELES CA
90074-3749
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-3300
  • Fax: 303-682-3380
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDR.0072957
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: