Healthcare Provider Details

I. General information

NPI: 1700557287
Provider Name (Legal Business Name): JORGE S CORREIA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BASELINE RD STE 200
BOULDER CO
80303-2668
US

IV. Provider business mailing address

4770 BASELINE RD STE 200
BOULDER CO
80303-2668
US

V. Phone/Fax

Practice location:
  • Phone: 720-679-8259
  • Fax: 888-437-8409
Mailing address:
  • Phone: 720-679-8259
  • Fax: 888-437-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996956-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: