Provider Demographics
NPI:1710796545
Name:THEOHARATOS, JESSICA A (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:THEOHARATOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 THUNDER RIDGE WAY UNIT 203
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-3271
Mailing Address - Country:US
Mailing Address - Phone:623-734-2228
Mailing Address - Fax:
Practice Address - Street 1:8407 THUNDER RIDGE WAY UNIT 203
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-3271
Practice Address - Country:US
Practice Address - Phone:623-734-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1656824163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse