Individual provider Active NPI

Jolene Lyn Nawrocki, DNP, FNP

  • Family Nurse Practitioner
  • Wheat Ridge, CO
National Provider Identifier
1821587908
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0993674 Issued in CO
Practice address
5790 W 39TH Place
Wheat Ridge, CO 80212
Phone
(720) 299-0247
NPI assigned
May 4, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0993674 CO Primary

Addresses

Primary practice location

5790 W 39TH Place
Wheat Ridge, CO 80212

Mailing address

5790 W 39TH PL
Wheat Ridge, CO 80212-7259
Phone (303) 945-6819

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180802001215 CO Practitioner - Nurse Practitioner 8224386503 Reassigns benefits to 2 organizations
I20210212002170 CA Practitioner - Nurse Practitioner 8224386503 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0993674COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Moazam PA CurrentSince Jul 1, 2020 Accepting new patients
Ultimate Health Medical Clinic Inc CurrentSince Jun 19, 2018 Accepting new patients
Moazam PA CurrentSince Jul 1, 2020 Accepting new patients
IHS Medical Group PC CurrentSince Jan 1, 2021 Accepting new patients
Ultimate Health Medical Center Inc Past Accepting new patients

Locations

10921 Wilshire Blvd
Ste 801
Los Angeles, CA 90024
Phone (310) 209-0425

10850 Wilshire Blvd
Ste 1130
Los Angeles, CA 90024
Phone (310) 209-0425

7735 W Long Dr
Unit 12
Littleton, CO 80123
Phone (303) 904-0331

1700 W 100th Ave
Ste 101
Thornton, CO 80260
Phone (720) 515-9112

1700 W 100th Ave
Ste 100
Thornton, CO 80260

14470 Horizon Blvd
Ste A
Horizon City, TX 79928

14470 Horizon Blvd
Ste Aj
Horizon City, TX 79928

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1821587908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5790 W 39TH PL",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "802127259",
            "telephone_number": "303-945-6819",
            "fax_number": "720-864-0608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5790 W 39TH PLACE",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "80212",
            "telephone_number": "720-299-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAWROCKI",
        "first_name": "JOLENE",
        "middle_name": "LYN",
        "credential": "DNP, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-04",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0993674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.