Provider Demographics
NPI:1215463666
Name:LOTT, JENNIFER (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 SERENE CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2455
Mailing Address - Country:US
Mailing Address - Phone:719-453-5227
Mailing Address - Fax:
Practice Address - Street 1:913 SERENE CT
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2455
Practice Address - Country:US
Practice Address - Phone:719-453-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60737324363LF0000X
COAPN.0993870.NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0993870.NPMedicaid