Healthcare Provider Details

I. General information

NPI: 1003457276
Provider Name (Legal Business Name): NATHANIEL CIVILI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 05/13/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 ALOHA ST STE 100
CASTLE ROCK CO
80108-2833
US

IV. Provider business mailing address

1151 ALOHA ST STE 100
CASTLE ROCK CO
80108
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-1305
  • Fax: 720-452-2079
Mailing address:
  • Phone: 720-330-1305
  • Fax: 720-452-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994776-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: