Healthcare Provider Details

I. General information

NPI: 1366094146
Provider Name (Legal Business Name): ASHLEY MICHELLE EATON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N ACADEMY BLVD STE 104
COLORADO SPRINGS CO
80917-5351
US

IV. Provider business mailing address

2910 N ACADEMY BLVD STE 104
COLORADO SPRINGS CO
80917-5351
US

V. Phone/Fax

Practice location:
  • Phone: 719-888-9943
  • Fax: 719-405-0504
Mailing address:
  • Phone: 719-888-9943
  • Fax: 719-405-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberAPN.0994766-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberAPN.0994766-NP
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberAPN.0994766-NP
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0994766-NP
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0203588
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAPN.0994766-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: