Provider Demographics
NPI:1356777668
Name:FITZGERALD, VANESSA NICOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:NICOLE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W SOUTH BOULDER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1157
Mailing Address - Country:US
Mailing Address - Phone:720-639-2736
Mailing Address - Fax:
Practice Address - Street 1:315 W SOUTH BOULDER RD STE 208
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1157
Practice Address - Country:US
Practice Address - Phone:720-639-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA699833OtherRN LICENSE