MEDICARE: NATHANIEL CIVILI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0994776-NP	CO

General Provider Information

NPI Number	:	1003457276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL CIVILI NP

Provider Business Mailing Address
First Line	:	1151 ALOHA ST
Second Line	:	STE 100
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108
Country	:	US
Telephone Number	:	720-330-1305
Fax Number	:	720-452-2079

Provider Business Practice Location Address
First Line	:	1151 ALOHA ST
Second Line	:	STE 100
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-2833
Country	:	US
Telephone Number	:	720-330-1305
Fax Number	:	720-452-2079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	05/13/2025

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