Healthcare Provider Details

I. General information

NPI: 1205203098
Provider Name (Legal Business Name): NANCY PRANTL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 GOLD PASS HTS
COLORADO SPRINGS CO
80906-3882
US

IV. Provider business mailing address

3205 N ACADEMY BLVD SUITE 130
COLORADO SPRINGS CO
80917-5101
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5700
  • Fax: 719-344-7817
Mailing address:
  • Phone: 719-344-7158
  • Fax: 719-344-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0991893-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: