Provider Demographics
NPI:1346210853
Name:CORCORAN, MIKE (RN FNP)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 S COORS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4960
Mailing Address - Country:US
Mailing Address - Phone:303-583-5848
Mailing Address - Fax:
Practice Address - Street 1:6179 S BALSAM WAY
Practice Address - Street 2:110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3091
Practice Address - Country:US
Practice Address - Phone:303-948-1570
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO150707 4379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily