Healthcare Provider Details

I. General information

NPI: 1780292045
Provider Name (Legal Business Name): JORGE LUIS SERNA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-9250
  • Fax: 303-602-9262
Mailing address:
  • Phone: 303-602-9250
  • Fax: 303-602-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPN.0995683-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: