Jackson, Diana Marie

Jackson, Diana Marie is an individual health care provider with primary practice located at 1025 Pennock Pl , Fort Collins CO 80524-3257. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Jackson, Diana Marie can be contacted via phone (970) 495-8800.

Contact Information

Primary practice address
1025 Pennock Pl Fort Collins CO 80524-3257
Phone: (970) 495-8800
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 573806 California
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APN.0004850-NP Colorado

Profile Details

NPI number 1083837843
LBN Legal business name Jackson, Diana Marie
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2007
Last updated Mar 14th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083837843 NPPES
Colorado MEDICAID 41101359

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