Provider Demographics
NPI:1851067193
Name:OLLILA RODRIGUEZ, TERESA (AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:OLLILA RODRIGUEZ
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 SHOSHONE TRL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3342
Mailing Address - Country:US
Mailing Address - Phone:303-550-6962
Mailing Address - Fax:
Practice Address - Street 1:7850 VANCE DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2118
Practice Address - Country:US
Practice Address - Phone:720-608-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996818-CNS364SA2200X
CO0996818364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health