MEDICARE: JODY MITTIGA ANP, ANP-BC

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	363LP2300X	Primary Care Nurse Practitioner	990325	CO
2	363LA2200X	Adult Health Nurse Practitioner	990325	CO

General Provider Information

NPI Number	:	1831462928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY MITTIGA ANP, ANP-BC

Provider Business Mailing Address
First Line	:	333 COMMERCE ST STE 700
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37201-1835
Country	:	US
Telephone Number	:	303-390-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	8354 E NORTHFIELD BLVD STE 3700
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3131
Country	:	US
Telephone Number	:	303-390-0208
Fax Number	:

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

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	06/19/2019

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