Healthcare Provider Details

I. General information

NPI: 1841418696
Provider Name (Legal Business Name): ROSARIO MEDINA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13120 E 19TH AVE C288-5
AURORA CO
80045-2567
US

IV. Provider business mailing address

13120 E 19TH AVE C288-5
AURORA CO
80045-2567
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-8816
  • Fax: 303-724-8560
Mailing address:
  • Phone: 303-724-8816
  • Fax: 303-724-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2540642
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 0991550-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: