Healthcare Provider Details

I. General information

NPI: 1497324669
Provider Name (Legal Business Name): JAMES ALAN MIJATOVIC NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

IV. Provider business mailing address

4601 CORBETT DR
FORT COLLINS CO
80528-9579
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4857
  • Fax: 970-207-4885
Mailing address:
  • Phone: 970-207-4857
  • Fax: 970-207-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996633-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: