Provider Demographics
NPI:1083222897
Name:LONGSHORE, JENNIFER DIANE (PNP- PC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:LONGSHORE
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Gender:
Credentials:PNP- PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:303-798-3248
Practice Address - Street 1:7720 S BROADWAY STE 540
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2635
Practice Address - Country:US
Practice Address - Phone:303-779-3013
Practice Address - Fax:303-779-0343
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO0995027363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics