Provider Demographics
NPI:1447985460
Name:DITIRRO, SARA (FNP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DITIRRO
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 1:11700 W 2ND PL STE 435
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1732
Mailing Address - Country:US
Mailing Address - Phone:720-321-8410
Mailing Address - Fax:
Practice Address - Street 1:11700 W 2ND PL STE 435
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1732
Practice Address - Country:US
Practice Address - Phone:720-321-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0997781363LF0000X
COAPN.0997781-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty