MEDICARE: CAROLINE IVETTE PENA NURSE PRACTITIONER

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.0999879-NP	CO

General Provider Information

NPI Number	:	1649013814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE IVETTE PENA NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	834 S PERRY ST STE F
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1941
Country	:	US
Telephone Number	:	720-435-7782
Fax Number	:

Provider Business Practice Location Address
First Line	:	834 S PERRY ST STE F
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1941
Country	:	US
Telephone Number	:	720-435-7782
Fax Number	:

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

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	01/01/2026

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