Healthcare Provider Details

I. General information

NPI: 1972135408
Provider Name (Legal Business Name): EMILY BRIANNE TOLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E BOULDER ST STE 101
COLORADO SPRINGS CO
80909-5740
US

IV. Provider business mailing address

1725 E BOULDER ST STE 101
COLORADO SPRINGS CO
80909-5740
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6300
  • Fax: 719-365-6094
Mailing address:
  • Phone: 719-365-6300
  • Fax: 719-365-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0008861
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-112149
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008861
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: