Healthcare Provider Details

I. General information

NPI: 1043354087
Provider Name (Legal Business Name): CAROL DENISE PRIZZNICK NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL DENISE PRIZZNICK NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 S CLERMONT STREET
DENVER CO
80222-6588
US

IV. Provider business mailing address

400 BORADACRES DRIVE STE 445
BLOOMFIELD NJ
07003-3156
US

V. Phone/Fax

Practice location:
  • Phone: 720-974-7275
  • Fax: 973-661-8333
Mailing address:
  • Phone: 739-661-8300
  • Fax: 973-661-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351252
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0995919-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: