Healthcare Provider Details

I. General information

NPI: 1518564194
Provider Name (Legal Business Name): SAMANTHA L CERQUA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 W 48TH AVE STE 500
DENVER CO
80212-2732
US

IV. Provider business mailing address

5335 W 48TH AVE STE 500
DENVER CO
80212-2732
US

V. Phone/Fax

Practice location:
  • Phone: 720-316-6089
  • Fax: 720-806-5244
Mailing address:
  • Phone: 303-617-2838
  • Fax: 720-806-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996725-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: