Provider Demographics
NPI:1750553152
Name:DEPERI, DANIELLA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:MARIE
Last Name:DEPERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 S TIMBERLINE RD APT 5-201
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4682
Mailing Address - Country:US
Mailing Address - Phone:854-444-9702
Mailing Address - Fax:
Practice Address - Street 1:3726 S TIMBERLINE RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4332
Practice Address - Country:US
Practice Address - Phone:970-221-5795
Practice Address - Fax:970-221-1371
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007924363A00000X
NJ25MP00124700363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical