Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | C-APN.0002514-C-NP | CO |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN241143 | GA |
NPI | 1023589454 |
---|---|
Provider Name | Mrs. Jasmine Diane Mccorkle Shytle |
First Address | Denver, CO 80224-2522 |
Second Address | Aurora, CO 80010-1517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2018 |
Last Update Date | 03/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000194320 | (05) | CO |