Provider Demographics
NPI:1154598050
Name:MIZONES, HEIDI TERESA (FNP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:TERESA
Last Name:MIZONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:T
Other - Last Name:VAN VOLKENBURGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10240 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5425
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1682872085R0202X, 363LF0000X
COAPN.0005697-NP363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1154598050Medicaid
CO36351288Medicaid
TX3109324Medicaid
COCO306359OtherRIA MEDICARE TBLZR
COCO306359OtherRIA MEDICARE TBLZR