# JEFFREY MADISON DOUGLASS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1366604506
- **Gender:** Man
- **Credential:** ANP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 304819 | NY | — |
| 363LA2200X | Adult Health Nurse Practitioner | C-APN.0000199-C-NP | CO | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | CNP01482 | NM | — |
| 363LA2200X | Adult Health Nurse Practitioner | R67367 | NM | — |

## Other

- **Enumeration date:** 06/30/2008
- **Last updated:** 06/24/2020