Healthcare Provider Details

I. General information

NPI: 1831462928
Provider Name (Legal Business Name): JODY MITTIGA ANP, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 E NORTHFIELD BLVD STE 3700
DENVER CO
80238-3131
US

IV. Provider business mailing address

333 COMMERCE ST STE 700
NASHVILLE TN
37201-1835
US

V. Phone/Fax

Practice location:
  • Phone: 303-390-0208
  • Fax:
Mailing address:
  • Phone: 303-390-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number990325
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number990325
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: