Provider Demographics
NPI:1649013814
Name:PENA, CAROLINE IVETTE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:IVETTE
Last Name:PENA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S LISBON CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-7406
Mailing Address - Country:US
Mailing Address - Phone:720-435-7782
Mailing Address - Fax:
Practice Address - Street 1:3601 S LISBON CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-7406
Practice Address - Country:US
Practice Address - Phone:720-435-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999879-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily