Basic Information
| Provider Information | |||||||||
| NPI: | 1427083997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JARDINICO | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 LUTHERAN PKWY | ||||||||
| Address2: | SUITE G20 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034033670 | ||||||||
| FaxNumber: | 3034239293 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 LUTHERAN PKWY | ||||||||
| Address2: | SUITE G20 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034033670 | ||||||||
| FaxNumber: | 3034239293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 829 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P007748496 | 01 | MEDICARE RAILROAD | OTHER | 18927777 | 05 | CO | MEDICAID |