Healthcare Provider Details

I. General information

NPI: 1861315707
Provider Name (Legal Business Name): ALYSSA MANDARANO AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N CIRCLE DR
COLORADO SPRINGS CO
80909-5121
US

IV. Provider business mailing address

13604 NEDERLAND DR
PEYTON CO
80831-7292
US

V. Phone/Fax

Practice location:
  • Phone: 302-258-6081
  • Fax:
Mailing address:
  • Phone: 302-258-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.1001616-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: