Provider Demographics
NPI:1700091584
Name:FLORES, JENNIFER LYNN (PA C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:FLORES
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E 104TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4402
Mailing Address - Country:US
Mailing Address - Phone:303-452-2766
Mailing Address - Fax:303-252-8694
Practice Address - Street 1:2200 E 104TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4402
Practice Address - Country:US
Practice Address - Phone:303-452-2766
Practice Address - Fax:303-252-8694
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0002291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12230758Medicaid
CO1355304OtherSUPERVISING PHYSICIAN MEDICAID
CO1790992238OtherGROUP NPI
COG60634OtherGROUP UPIN
CO1548345101OtherSUPERVISING PHYSICIAN NPI