Healthcare Provider Details

I. General information

NPI: 1841766268
Provider Name (Legal Business Name): AZURE GRISSOM APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 MEADOWS BLVD
CASTLE ROCK CO
80109-8405
US

IV. Provider business mailing address

2350 MEADOWS BLVD
CASTLE ROCK CO
80109-8405
US

V. Phone/Fax

Practice location:
  • Phone: 720-455-0489
  • Fax: 720-455-0471
Mailing address:
  • Phone: 720-455-0489
  • Fax: 720-455-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994256-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: