Provider Demographics
NPI:1487258968
Name:GUGAT, IVY (NP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:GUGAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19563 E MAINSTREET STE 206B
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7367
Mailing Address - Country:US
Mailing Address - Phone:970-300-1197
Mailing Address - Fax:888-314-8161
Practice Address - Street 1:19563 E MAINSTREET STE 206B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7367
Practice Address - Country:US
Practice Address - Phone:970-300-1197
Practice Address - Fax:888-314-8161
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0996165363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health