Individual
MS. DIANA MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1025 PENNOCK PL, FORT COLLINS, CO 80524-3257
(970) 495-8800
Mailing address
1025 PENNOCK PL, SUITE 114, FORT COLLINS, CO 80524-3257
(970) 495-8800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
573806
CA
363LF0000X
Family Nurse Practitioner
Primary
APN.0004850-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41101359
—
CO
Enumeration date
04/10/2007
Last updated
03/14/2016
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