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General NPI Number Information
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NPI Number | 1629843362
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Entity Type | Organization
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Legal Business Name | HEARTLIGHT FAMILY CLINIC, LLC
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1421 S POTOMAC ST STE 300
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City | AURORA
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State | CO
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Zip | 80012-4512
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Country | US
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Telephone | 204-853-1787
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 S POTOMAC ST STE 140
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City | AURORA
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State | CO
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Zip | 80012-4535
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Country | US
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Telephone | 204-853-1787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENT HERRON
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Credential |
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Telephone | 303-249-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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