Provider Demographics
NPI:1578796355
Name:MISPIRETA, HERNANDO A (ACNPC)
Entity Type:Individual
Prefix:MR
First Name:HERNANDO
Middle Name:A
Last Name:MISPIRETA
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Gender:M
Credentials:ACNPC
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Mailing Address - Street 1:8950 E LOWRY BLVD
Mailing Address - Street 2:INNOVAGE LOWRY ATTN: GAYLE WASHINGTON
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7030
Mailing Address - Country:US
Mailing Address - Phone:303-869-4664
Mailing Address - Fax:303-996-1600
Practice Address - Street 1:445 E 124TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2402
Practice Address - Country:US
Practice Address - Phone:303-327-1189
Practice Address - Fax:303-327-1197
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02455363L00000X, 363LC0200X
FLARNP9217836363LA2100X
COAPN 0991183-NP364SG0600X
COAPN.991183-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid