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General NPI Number Information
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NPI Number | 1417363763
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Entity Type | Individual
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Provider Name | JENNA TATGENHORST PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 350 INDIANA ST STE 250
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City | GOLDEN
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State | CO
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Zip | 80401-5074
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Country | US
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Telephone | 720-898-9427
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 303-763-4900
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Fax | 303-763-5495
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0006736
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0006736
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License Number State | CO
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