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General NPI Number Information
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NPI Number | 1992463970
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Entity Type | Individual
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Provider Name | JACOB DANIEL SHIRLEY PA
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Gender | Male
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1925 MOUNTAIN VIEW AVE FL 3
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City | LONGMONT
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State | CO
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Zip | 80501-3128
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Country | US
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Telephone | 720-718-8240
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Fax | 720-718-0953
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Provider Business Mailing Address
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Address Line | 1925 MOUNTAIN VIEW AVE FL 3
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City | LONGMONT
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State | CO
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Zip | 80501-3128
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Country | US
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Telephone | 720-718-8240
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Fax | 720-718-0953
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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 | PA1128
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-2185
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0009178
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License Number State | CO
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