Provider Demographics
NPI:1104103399
Name:MAURER, JACINDA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:JACINDA
Middle Name:ANN
Last Name:MAURER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JACINDA
Other - Middle Name:ANN
Other - Last Name:CROISSANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4725 GRACE STREET
Mailing Address - Street 2:APT. 1
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:303-275-7582
Mailing Address - Fax:
Practice Address - Street 1:4725 GRACE STREET
Practice Address - Street 2:APT. 1
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010
Practice Address - Country:US
Practice Address - Phone:720-220-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO195879163WC1500X
CA95021915163W00000X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis