Healthcare Provider Details

I. General information

NPI: 1235305061
Provider Name (Legal Business Name): ANDREA A BONANNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3733
US

IV. Provider business mailing address

1420 AUSTIN BLUFFS PKWY
COLORADO SPRINGS CO
80918-3735
US

V. Phone/Fax

Practice location:
  • Phone: 719-255-4444
  • Fax: 719-255-4446
Mailing address:
  • Phone: 719-255-4444
  • Fax: 719-255-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0999635-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: