Healthcare Provider Details

I. General information

NPI: 1811478225
Provider Name (Legal Business Name): AQUILA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 MAJESTIC ST
FREDERICK CO
80504-6933
US

IV. Provider business mailing address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-7351
  • Fax: 303-586-0943
Mailing address:
  • Phone: 970-347-2120
  • Fax: 303-586-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0995582
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1637977
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: