Provider Demographics
NPI:1710334081
Name:BERARDUCCI, ASHLEY (N P)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BERARDUCCI
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 7035
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0100
Mailing Address - Country:US
Mailing Address - Phone:719-301-7731
Mailing Address - Fax:
Practice Address - Street 1:2993 BROADMOOR VALLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4471
Practice Address - Country:US
Practice Address - Phone:719-301-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992113-NP363LA2200X, 363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1710334081Medicaid