Active NPI
Stacy C Derrera, NP
- Nurse Practitioner
- Elizabeth, CO
National Provider Identifier
1144867243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- APN.0995141-NP
- Practice address
- 309 Rushmore St
Elizabeth, CO 80107-7928 - Phone
- (970) 619-9084
- NPI assigned
- Dec 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN.0995141-NP | CO | Primary |
Addresses
Primary practice location
309 Rushmore St
Elizabeth, CO 80107-7928
Mailing address
10900 W 44TH Ave
Unit 200
Wheat Ridge, CO 80033-2742
Phone (303) 993-1330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN.0995141-NP | CO | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578528000000",
"number": "1144867243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10900 W 44TH AVE",
"address_2": "UNIT 200",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800332742",
"telephone_number": "303-993-1330",
"fax_number": "303-284-4082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 RUSHMORE ST",
"city": "ELIZABETH",
"state": "CO",
"postal_code": "801077928",
"telephone_number": "970-619-9084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRERA",
"first_name": "STACY",
"middle_name": "C",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-08",
"last_updated": "2020-01-09",
"certification_date": "2020-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CO",
"license": "APN.0995141-NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabeth, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.