Healthcare Provider Details

I. General information

NPI: 1588502660
Provider Name (Legal Business Name): JACOB LEE HOLMQUIST FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN ST
WINDSOR CO
80550-5989
US

IV. Provider business mailing address

1300 MAIN ST
WINDSOR CO
80550-5989
US

V. Phone/Fax

Practice location:
  • Phone: 970-686-5646
  • Fax:
Mailing address:
  • Phone: 970-686-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1000909-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: