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General NPI Number Information
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NPI Number | 1275990491
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Entity Type | Individual
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Provider Name | JOVAN MACK FNP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 6895 E HAMPDEN AVE
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City | DENVER
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State | CO
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Zip | 80224-3047
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Country | US
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Telephone | 303-218-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 605 PARFET ST
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City | LAKEWOOD
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State | CO
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Zip | 80215-5576
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Country | US
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Telephone | 303-986-9583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0992154-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53745
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License Number State | NM
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