Healthcare Provider Details

I. General information

NPI: 1720831688
Provider Name (Legal Business Name): CAROLINE ANNE JOURNEYCAKE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E MISSISSIPPI AVE STE 1300
DENVER CO
80246-3057
US

IV. Provider business mailing address

4100 E MISSISSIPPI AVE STE 1300
DENVER CO
80246-3057
US

V. Phone/Fax

Practice location:
  • Phone: 720-889-4254
  • Fax: 720-889-4258
Mailing address:
  • Phone: 720-889-4254
  • Fax: 720-889-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0999662
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: