Healthcare Provider Details

I. General information

NPI: 1598201337
Provider Name (Legal Business Name): JOHN TRIPP RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 E 4TH AVE
AURORA CO
80011
US

IV. Provider business mailing address

6703 W ROXBURY PL
LITTLETON CO
80128-4558
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax:
Mailing address:
  • Phone: 720-626-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0995069
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: