MEDICARE: DR. LISSA DACOSCOS ACNP

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363LA2100X	Acute Care Nurse Practitioner	APN.0995826-NP	CO

General Provider Information

NPI Number	:	1386271518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISSA DACOSCOS ACNP

Provider Business Mailing Address
First Line	:	2603 GENEVA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3038
Country	:	US
Telephone Number	:	303-726-7765
Fax Number	:

Provider Business Practice Location Address
First Line	:	1716 E 19TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218
Country	:	US
Telephone Number	:	720-754-2296
Fax Number	:

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	02/01/2023

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