Provider Demographics
NPI:1598506990
Name:DEANGELIS, TRAVIS ANSELMO (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ANSELMO
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC
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Mailing Address - Street 1:19590 E MAINSTREET STE 202&204
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2675 S ABILENE ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2363
Practice Address - Country:US
Practice Address - Phone:720-507-4779
Practice Address - Fax:833-941-5047
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0999792-NP363LP0808X
CORXN.0108854-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORXN.0108854-NPOtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES