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:
Health care specialties
| Specialty | Code | License # | 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 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083837843 | NPPES |
| Colorado | MEDICAID | 41101359 |
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