Provider Demographics
NPI:1275359127
Name:JACKSON, SAREYNA CAMILLE (RN)
Entity type:Individual
Prefix:
First Name:SAREYNA
Middle Name:CAMILLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20048 E 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2290
Mailing Address - Country:US
Mailing Address - Phone:678-483-3839
Mailing Address - Fax:
Practice Address - Street 1:2369 S TRENTON WAY STE H
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3828
Practice Address - Country:US
Practice Address - Phone:720-814-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1621246163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse