Individual
ALEXANDER NICHOLAS JENIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2322 S ACADEMY BLVD, COLORADO SPRINGS, CO 80916-2406
(719) 390-1727
Mailing address
1510 BISON RIDGE DR, COLORADO SPRINGS, CO 80919-1541
(719) 271-7193
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0005988
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163223
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
01
—
PA.0005988
STATE MEDICAL LICENSE NUMBER
CO
Enumeration date
10/24/2019
Last updated
10/24/2019
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