Healthcare Provider Details

I. General information

NPI: 1356007322
Provider Name (Legal Business Name): CARA CHRISTINA ZAGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 01/24/2024
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-7837
US

IV. Provider business mailing address

4110 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-7837
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-7669
  • Fax: 719-632-0088
Mailing address:
  • Phone: 719-632-7669
  • Fax: 719-632-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1072
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008218
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: